Acute and Time-Course Effects of Osteopathic Manipulative Treatment on Vascular and Autonomic Function in Patients With Heart Failure: A Randomized Trial

ObjectiveThe purposed of this study was to valuate the effect of osteopathic manipulative treatment (OMT) on flow-mediated dilation and heart rate variability of patients with heart failure.BackgroundOsteopathic manipulative treatment modulates both the vascular and autonomic nervous system (ANS) in healthy volunteers. However, the acute and time-course effects of the OMT on patients with an overactive ANS remain unclear.MethodsThis randomized controlled trial study included 20 patients with heart failure aged 50 to 60 years, allocated to a single session of OMT (base of the skull, retromaxillary region, heart, and thoracic duct) or sham. Flow-mediated dilation (FMD) at the brachial artery, hemodynamic measures, and heart rate variability were assessed in 3 periods (baseline, immediately after the intervention, and after 15 minutes). Multivariate analysis of variance procedure was used to compare intervention and periods.ResultsThe OMT group had a greater FMD modulation compared with the sham (FMD,% = 9.5 vs. –5.6, 95% confidence interval (CI): [6.6, –12.35] vs. [–14.25, 2.8]; p = 0.001) and grater peak diameter (PD, mm = 0.77 vs –0.16 mm, 95% CI: [0.31,-1.24] vs [–0.63, 0.29]; P = 0.001), suggesting an important acute and time-course vascular effect from OMT. We also found some relevant heart rate variability modulation after 15 minutes from OMT: high frequency (HF, ms² = 295 vs –354, 95% CI: [144.2, -769]; P = .001) and low frequency (LF, ms²) = 670 vs 775, 95% CI: [–98, 3591]; P = .001), suggesting a time-course ANS modulation after OMT.ConclusionsOsteopathic manipulative treatment was effective at increasing brachial blood flow and stimulating the vagal system in patients with heart failure. Moreover, vascular changes seem to precede the autonomic modulation.     

Effect of theophylline on ventilator-induced diaphragmatic dysfunction

PurposeTo evaluate the effect of theophylline in patients with ventilator-induced diaphragmatic dysfunction (VIDD).Materials and MethodsPatients who required mechanical ventilation at least 72 hours, met the criteria for a spontaneous breathing trial, and had evidence of VIDD by ultrasonography were included in the study.ResultsOf the 40 patients, 21 received theophylline and 19 did not. Clinical characteristics were similar in the 2 groups. Assessment of VIDD showed no between-group differences in baseline diaphragmatic excursion (DE) of both hemidiaphragms. Changes in DE from baseline to 72 hours (ΔDE) were significantly higher in the theophylline group than in the nontheophylline group in the right (3.5 ± 4.5 mm vs 0.4 ± 2.1 mm; P = .004) and left (3.2 ± 5.1 mm vs 0.1 ± 4.0 mm; P = .03) hemidiaphragms and in the total DE of both diaphragms (6.9 ± 9.1 mm vs 0.5 ± 5.7 mm; P = .02). In the theophylline group, theophylline was effective for the diaphragms with VIDD, whereas it was not effective for the diaphragms without VIDD. ΔDE in the right (r_s = − 0.49, P = .006) hemidiaphragm and total Δ DE in both diaphragms (r_s = − 0.46, P = .01) correlated negatively with weaning time.ConclusionsTheophylline significantly improved diaphragmatic movements in patients with VIDD. Our results warrant a larger study to determine whether theophylline use has benefits during weaning from mechanical ventilation.     

超声测量膈肌运动诊断慢性阻塞性肺疾病

目的 探讨M型超声测量膈肌头尾向运动幅度与运动时间变化诊断慢性阻塞性肺疾病（COPD）的价值。方法 运用M型超声观察68例稳定期COPD患者（COPD组）和68名健康志愿者（对照组）膈肌头尾向运动幅度与运动时间,比较两组间平静呼吸与深呼吸时膈肌运动幅度与运动时间,分析膈肌运动幅度与肺功能的相关性,采用ROC曲线判断M型超声诊断COPD的效能。结果 平静呼吸时,COPD组双侧膈肌运动幅度大于对照组;深呼吸时,对照组双侧膈肌运动幅度大于COPD组;平静呼吸和深呼吸时,对照组右侧的膈肌运动时间均大于COPD组（P均<0.05）。深呼吸时,膈肌运动幅度与第1秒用力呼气容积（FEV1）、FEV1/用力肺活量均呈正相关（P均<0.05）。平静呼吸和深呼吸时,膈肌运动幅度诊断COPD的ROC曲线下面积（AUC）为0.823、0.858;膈肌运动时间诊断COPD的AUC分别为0.620、0.678。结论 M型超声可通过判断膈肌运动情况快捷地评估膈肌功能,可辅助诊断COPD。     

动态X线胸片评估平静呼吸下慢性阻塞性肺疾病患者横膈运动

目的 观察动态X线胸片定量分析平静呼吸下慢性阻塞性肺疾病（COPD）患者横膈运动的价值。方法 对96例COPD患者（COPD组）和50名健康对照者（对照组）行平静呼吸下动态X线胸片检查，经后处理获得横膈运动幅度、速度及时间；记录2组肺功能检查结果，比较组间动态X线胸片及肺功能参数值差异，分析COPD横膈运动参数与肺功能参数的相关性。结果 平静呼吸下COPD组左、右侧横膈运动幅度[（18.63±7.45）mm、（15.64±5.98）mm]均大于对照组[（14.69±5.40）mm、（13.13±4.84）mm，P均<0.05]；吸气时和呼气时COPD组左侧横膈运动速度18.79（15.67，22.67）mm/s、16.00（12.36，21.23）mm/s，右侧为17.00（12.71，19.73）mm/s、13.75（9.50，16.83）mm/s；对照组左侧为15.33（13.96，17.71）mm/s、11.42（9.63，16.00）mm/s，右侧为（14.91±4.38）mm/s、（10.66±3.66）mm/s（P均<0.05）。2组肺功能检查结果差异均有统计学意义（P均<0.01）。COPD组肺功能参数与动态胸片检查各参数均无明显相关（P均>0.05）。结论 动态X线胸片可定量分析COPD患者横膈运动，有望为临床精准评估COPD提供新的手段。     

CT征象诊断创伤性膈肌破裂

目的 探讨CT征象诊断创伤性膈肌破裂的价值。方法 回顾性分析256例可疑创伤性膈肌破裂的胸腹部损伤患者的资料,经手术证实膈肌破裂128例,膈肌无破裂128例。对所有患者术前均行CT检查,观察CT征象包括膈肌连续性中断或膈肌部分未显示、领口征、腹腔内容物进入胸腔、腹部内脏依靠、膈肌移位、膈肌增厚,计算各征象诊断创伤性膈肌破裂的敏感度和特异度。结果 膈肌连续性中断或部分未显示诊断创伤性膈肌破裂的敏感度和特异度分别为75.00%（96/128）和93.75%（120/128）,领口征为84.37%（108/128）和98.43%（126/128）,腹腔内容物进入胸腔为78.13%（100/128）和98.43%（126/128）,腹部内脏依靠为76.56%（98/128）和99.21%（127/128）,膈肌移位为54.68%（70/128）和93.75%（120/128）,膈肌增厚为46.87%（60/128）和84.38%（108/128）。MSCT征象综合诊断的敏感度为92.18%（118/128）,特异度为100%（128/128）。结论 MSCT征象对创伤性膈肌破裂有较高的诊断价值。     

超声评价慢性阻塞性肺疾病患者膈肌运动异常

目的 探讨超声评价慢性阻塞性肺疾病（COPD）患者膈肌运动异常的价值。方法 收集64例COPD急性加重期患者,根据2017GOLD指南综合评估将其分为C组（n=34）和D组（n=30）,以超声测量膈肌厚度、膈肌运动幅度及对合角,计算膈肌增厚分数及膈肌移动度。结果 C组膈肌增厚分数和收缩速度均明显大于D组（P均<0.05）,而2组膈肌移动度和对合角差异无统计学意义（P均>0.05）。膈肌增厚分数与第1秒用力呼气量/用力肺活量（FEV1/FVC）呈正相关（r=0.26,P=0.04）,膈肌移动度（r=0.35,P<0.01）、膈肌收缩速度（r=0.43,P<0.01）均与FVC呈正相关。DTF对鉴别诊断C、D组COPD性能相对较好（AUC为0.78）,DTF=30.22%,其诊断敏感度70.60%,特异度83.30%。结论 超声可评价COPD患者膈肌功能障碍,指导稳定期康复治疗。     

Quantification of Diaphragm Function Using Ultrasound: Evaluation of a Novel Technique

A novel method of image analysis for quantifying diaphragmatic motion is described using ultrasound. Nineteen patients scheduled for thoracic surgery were evaluated with ultrasound preoperatively and through their postoperative hospital stay. Diaphragmatic motion was measured using a horizontal on-screen ruler, allowing for quantification and tracking of dynamic diaphragm function. A percentage (73.5%) of all attempted measurements was quantifiable. Preoperative measurements of left and right diaphragm movement were correlated and there was no significant difference between the two. Postoperative diaphragm movement ipsilateral to the incision was statistically significantly less when compared to the contralateral side (p = 0.02 vs. p = 0.19). While not universally feasible in all patients, this method for quantifying diaphragmatic function is the only known imaging technique that can be performed at the bedside. Further evaluation of the impact of diaphragmatic dysfunction on patients undergoing thoracic surgery and its correlation with dyspnea is planned. (E-mail: tgethin-jones@partners.org)     

膈肌超声预测ICU机械通气患者拔管结局的临床研究

目的探讨超声测量膈肌增厚分数（DTF）在预测ICU机械通气患者拔管结局中的价值。 方法选择2017年6月至12月间台州市立医院和浙江医院ICU计划拔管的机械通气患者52例,根据拔管结局,将52例患者分为拔管成功组（38例）和拔管失败组（14例）。比较两组患者的一般资料,自主呼吸试验（SBT）结束时的呼吸频率、潮气量、浅快呼吸指数（RSBI）、氧合指数以及膈肌位移、吸气末膈肌厚度、呼气末膈肌厚度和DTF等膈肌超声相关参数。采用Logistic回归分析影响拔管结局的相关因素;采用受试者工作特征（ROC）曲线确定预测拔管成功的最佳阈值。 结果拔管成功组与拔管失败组患者SBT前机械通气时间[12（7,14）d vs. 16（11,17）d]、住ICU时间[14（8,17）d vs. 22（16,28）d]及住院时间[20（11,26）d vs. 34（26,41）d]比较,差异均有统计学意义（H = 2.109、2.881、3.459,P = 0.035、0.004、0.001）。SBT结束时,拔管成功组与拔管失败组患者呼吸频率[（19 ± 4）次/min vs.（22 ± 4）次/min]、潮气量[（360 ± 97）mL vs.（285 ± 87）mL]、RSBI [（61 ± 22）次·min^-1·L^-1 vs.（86 ± 33）次·min^-1·L^-1]、膈肌位移[（15 ± 4）mm vs.（11 ± 3）mm]、吸气末膈肌厚度[（2.4 ± 0.6）mm vs.（1.8 ± 0.7）mm]及DTF [（40 ± 9）% vs.（26 ± 7）%]比较,差异均有统计学意义（t = 2.272、2.558、3.154、3.610、2.406、5.180,P = 0.027、0.014、0.003、0.001、0.020、< 0.001）。将SBT前机械通气时间,SBT结束时呼吸频率、潮气量、RSBI、膈肌位移、吸气末膈肌厚度及DTF纳入Logistic回归分析。结果显示,仅DTF是影响ICU机械通气患者拔管结局的相关因素[比值比（OR）= 1.473,95%置信区间（CI）（1.054,2.058）,P = 0.023]。以> 30.8%为阈值,DTF预测拔管成功的敏感度和特异度分别为89.5%和85.7%,曲线下面积为0.903 [95%CI（0.760,1.000）,P < 0.001]。 结论对于接受SBT的ICU机械通气患者,超声评估DTF是预测拔管结局的良好指标。膈肌超声有助于早期发现膈肌功能障碍,指导ICU机械通气患者的拔管。     

脓毒症患者膈肌功能障碍的床旁超声评估的应用价值研究北大核心CSCD

目的探讨脓毒症及感染性休克患者膈肌功能障碍的危险因素及床旁超声评估的应用价值。方法前瞻性收集2020年1月至2021年5月入住宁夏医科大学总医院重症医学科(ICU)脓毒症及感染性休克患者作为研究对象,选择普通术后患者及健康志愿者作为术后对照组与正常对照组。收集一般临床资料,动态观察脓毒症及感染性休克患者超敏C反应蛋白(high sensitive c-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、血清白蛋白、转铁蛋白、前白蛋白水平、血乳酸、动静脉二氧化碳分压差、中心静脉血氧饱和度等指标。并用间接测热法测量静息能量水平计算能量缺失值,床旁超声评估膈肌移动度(diaphragm excursion,DE)、吸气末膈肌厚度及呼气末膈肌厚度,计算相关参数。DE<10 mm或膈肌增厚分数(diaphragmatic thickness fraction,DTF)<20%诊断为膈肌功能障碍。结果⑴感染性休克组、脓毒症组及术后对照组三组患者入ICU第1天,DE均低于正常对照组[10.3(9.0,13.6)mm、12.3(9.1,15.0)mm、12.9(10.5,15.7)mm vs.22.0(16.0,24.6)mm,均P<0.05];DTF<20%发生率均高于正常对照组(32.7%、41.9%、33.3%vs.0%,均P<0.05);且感染性休克组和脓毒症组DE<10 mm发生率均高于术后对照组和正常对照组(分别为36.7%、35.5%vs.10.0%、0%,均P<0.05)。入ICU第7天,感染性休克组DE较脓毒症组减低[10.5(6.8,13.5)mm vs.14.4(10.6,18.6)mm,P<0.05]。⑵各指标相关性分析:脓毒症和感染性休克患者入ICU第1、3、7天的DE均与当天的hs-CRP呈负相关(r值分别为-0.253、-0.436、-0.455,均P<0.05);入ICU第3天,DE还与IL-6呈负相关(r=-0.338,P=0.009),且DTF与hs-CRP呈负相关(r=-0.375,P=0.004)。入ICU第1天,脓毒症和感染性休克患者DTF与转铁蛋白呈正相关(r=0.221,P=0.049)。入ICU第3、7天,其DE与前白蛋白呈正相关(r值分别为0.318、0.408,均P<0.05)。结论脓毒症和感染性休克患者入住ICU首日已出现膈肌功能障碍,主要表现为膈肌移动度及膈肌增厚分数减低,且与炎症反应和蛋白质高分解代谢程度相关。     

Effect of Kinesiology Taping on Upper Torso Mobility and Shoulder Pain and Disability in US Masters National Championship Swimmers: An Exploratory Study

ObjectiveThe purpose of this study was to observe changes in shoulder pain and upper-extremity functional movement after kinesiology taping (KT) in competitive swimmers.MethodsSeventy-six healthy participants competing in the US Masters Swimming 2017 National Championship participated in the study. Participants performed functional movement of shoulder flexion along with Disabilities of the Arm, Shoulder, and Hand index assessments for the shoulder before and 30 minutes after application of KT.ResultsA change in the functional movement assessment was observed after KT application when compared to the pre-KT application (33.56 ± 1.39 cm vs 35.35 ± 1.52 cm, P < .001). A statistical significant change for pain and disability scores of 2.17 was observed (12.29 ± 1.22 vs 10.12 ± 1.16, P < .01).ConclusionFor the participants in this study, KT changed shoulder pain and active functional movement scores significantly in swimmers.     

Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial

Yamaguti WP, Claudino RC, Neto AP, Chammas MC, Gomes AC, Salge JM, Moriya HT, Cukier A, Carvalho CR. Diaphragmatic breathing training program improves abdominal motion during natural breathing in patients with chronic obstructive pulmonary disease: a randomized controlled trial.ObjectiveTo investigate the effects of a diaphragmatic breathing training program (DBTP) on thoracoabdominal motion and functional capacity in patients with chronic obstructive pulmonary disease.DesignA prospective, randomized controlled trial.SettingAcademic medical center.ParticipantsSubjects (N=30; forced expiratory volume in 1s, 42%±13% predicted) were randomly allocated to either a training group (TG) or a control group (CG).InterventionsSubjects in the TG completed a 4-week supervised DBTP (3 individualized weekly sessions), while those in the CG received their usual care.Main Outcome MeasuresEffectiveness was assessed by amplitude of the rib cage to abdominal motion ratio (RC/ABD ratio) (primary outcome) and diaphragmatic mobility (secondary outcome). The RC/ABD ratio was measured using respiratory inductive plethysmography during voluntary diaphragmatic breathing and natural breathing. Diaphragmatic mobility was measured by ultrasonography. A 6-minute walk test and health-related quality of life were also evaluated.ResultsImmediately after the 4-week DBTP, the TG showed a greater abdominal motion during natural breathing quantified by a reduction in the RC/ABD ratio when compared with the CG (F=8.66; P<.001). Abdominal motion during voluntary diaphragmatic breathing after the intervention was also greater in the TG than in the CG (F=4.11; P<.05). The TG showed greater diaphragmatic mobility after the 4-week DBTP than did the CG (F=15.08; P<.001). An improvement in the 6-minute walk test and in health-related quality of life was also observed in the TG.ConclusionsDBTP for patients with chronic obstructive pulmonary disease induced increased diaphragm participation during natural breathing, resulting in an improvement in functional capacity.     

Normal Diaphragmatic Motion and the Effects of Body Composition

Objective. To evaluate the quantitative measurement of diaphragmatic motion in healthy subjects and to investigate the effects of different variables such as body mass index and waist circumference on the diaphragmatic motion. Methods. The study included 164 healthy subjects. The subjects were grouped according to age, sex, body mass index, and waist circumference. Measurements of diaphragmatic motion were made by a 3.5‐MHz sonographic unit in the M‐mode of the system. The posterior diaphragm on both sides was identified, and measurements were performed during deep inspiration. Results. The mean diaphragmatic motion measurements ± SD were 49.23 ± 10.98 and 50.17 ± 11.73 mm on right and left sides, respectively. Female subjects had statistically significantly (P < .05) decreased diaphragmatic motion (right, 46.93 ± 10.37 mm; left, 47.57 ± 10.36 mm) than male subjects. The mean diaphragmatic motion (right, 40.90 ± 8.89 mm; left, 39.37 ± 9.15 mm) was less in subjects who were underweight (P < .05) when compared with subjects who were of normal weight, overweight, and obese. Subjects who had a waist circumference of less than 70 cm showed a statistically significant decrease (P < .05) in diaphragmatic motion (right, 42.55 ± 9.12 mm; left, 42.24 ± 9.73 mm) when compared with subjects who had a waist circumference of 70 to 85, 85 to 100, and greater than 100 cm. Also, subjects younger than 30 years had statistically significantly (P < .05) decreased diaphragmatic motion (right, 44.57 ± 10.57 mm; left, 44.44 ± 11.37 mm). Conclusions. Sex, body mass index, waist circumference, and age may affect the diaphragmatic motion to some extent. Healthy persons of younger age with a smaller body mass index and waist circumference may show a decreased amount of diaphragmatic motion.     

膈肌超声评分预测机械通气撤机的价值探讨

目的探讨膈肌超声评分在预测机械通气患者成功撤机中的价值。方法对64例机械通气患者行床旁超声检查,记录其自主呼吸试验时膈肌厚度的变化、双侧膈肌的运动幅度、膈肌相关的浅快呼吸指数(D-RSBI)。根据患者撤机是否成功分为撤机成功组39例和撤机失败组25例。绘制受试者工作特征(ROC)曲线分析自主呼吸试验时膈肌增厚率、膈肌运动幅度、D-RSBI对撤机失败的预测价值,根据最佳临界值将相关的连续性变量转化为二分类变量,进行多因素Logistic回归分析,建立膈肌超声评分系统,预测患者撤机失败率。结果撤机成功组和撤机失败组膈肌增厚率、膈肌运动幅度、D-RSBI比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示撤机成功患者膈肌增厚率的最佳临界值53%,敏感性89.6%,特异性45.4%,约登指数0.283;膈肌运动幅度的最佳临界值11.8 mm,敏感性62.3%,特异性79.4%,约登指数0.413;D-RSBI的最佳临界值1.7 mm·min/n,敏感性58.6%,特异性81.3%,约登指数0.312。膈肌增厚率≥53%、膈肌运动幅度≥11.8 mm及D-RSBI≤1.7 mm·min/n均是呼吸机撤机失败的独立影响因素(OR=5.982、2.966、4.356)。根据膈肌超声评分情况将25例撤机失败患者分为低危8例(0~2分)、中危11例(3~6分)和高危6例(7~8分),其撤机失败发生率分别为11.4%、52.6%、89.7%。结论膈肌超声评分可较准确地预测机械通气患者撤机结局,具有较好的临床应用价值。     

Effectiveness of osteopathic manipulative treatment versus osteopathy in the cranial field in temporomandibular disorders – a pilot study

Purpose: Temporomandibular disorders are a common musculoskeletal condition causing severe pain, physical and psychological disability. The effect and evidence of osteopathic manipulative treatment and osteopathy in the cranial field is scarce and their use are controversial. The purpose of this pilot study was to evaluate the effectiveness of osteopathic manipulative treatment and osteopathy in the cranial field in temporomandibular disorders.

Methods: A randomized clinical trial in patients with temporomandibular disorders was performed. Forty female subjects with long-term temporomandibular disorders (>3 months) were included. At enrollment, subjects were randomly assigned into two groups: (1) osteopathic manipulative treatment group (20 female patients) and (2) osteopathy in the cranial field group (20 female patients). Examination was performed at baseline (E0) and at the end of the last treatment (E1), consisting of subjective pain intensity with the Visual Analog Scale, Helkimo Index and SF-36 Health Survey. Subjects had five treatments, once a week. 36 subjects completed the study (33.7?±?10.3 y).

Results: Patients in both groups showed significant reduction in Visual Analog Scale score (osteopathic manipulative treatment group: p?=?0.001; osteopathy in the cranial field group: pp?=?0.02; osteopathy in the cranial field group: p?=?0.003) and a significant improvement in the SF-36 Health Survey – subscale “Bodily Pain” (osteopathic manipulative treatment group: p?=?0.04; osteopathy in the cranial field group: p?= 0.007) after five treatments (E1). All subjects (n?=?36) also showed significant improvements in the above named parameters after five treatments (E1): Visual Analog Scale score (ppBodily Pain” (p?=?0.001). The differences between the two groups were not statistically significant for any of the three target parameters.

Conclusion: Both therapeutic modalities had similar clinical results. The findings of this pilot trial support the use of osteopathic manipulative treatment and osteopathy in the cranial field as an effective treatment modality in patients with temporomandibular disorders. The positive results in both treatment groups should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field and support the importance of an interdisciplinary collaboration in patients with temporomandibular disorders.

• Implications for rehabilitation

• Temporomandibular disorders are the second most prevalent musculoskeletal condition with a negative impact on physical and psychological factors.

• There are a variety of options to treat temporomandibular disorders.

• This pilot study demonstrates the reduction of pain, the improvement of temporomandibular joint dysfunction and the positive impact on quality of life after osteopathic manipulative treatment and osteopathy in the cranial field.

• Our findings support the use of osteopathic manipulative treatment and osteopathy in the cranial field and should encourage further research on osteopathic manipulative treatment and osteopathy in the cranial field in patients with temporomandibular disorders.

• Rehabilitation experts should consider osteopathic manipulative treatment and osteopathy in the cranial field as a beneficial treatment option for temporomandibular disorders.

     

Computed tomography confirms a reduction in diaphragm thickness in mechanically ventilated patients

PurposePatients who require mechanical ventilation (MV) may experience diaphragm atrophy, which may delay the discontinuation of MV. Here, we used computed tomographic (CT) scans to confirm this phenomenon.Method and MaterialsPatients who underwent two chest CT scans while on MV were retrospectively evaluated. Diaphragm thickness was measured using a three-dimensional CT image processing program.ResultsThirteen patients, including 8 men, who underwent 26 CT scans were assessed. The mean age was 67.8 ± 7.5 years. The interval between CT scans was 18.4 ± 14.9 days. The first CT scans revealed that the mean thicknesses of the left and right sides of the diaphragm were 3.8 ± 0.6 and 3.9 ± 0.8 mm, respectively (total: 7.7 ± 1.4 mm). These values were significantly reduced to 3.4 ± 0.6 and 3.5 ± 0.9 mm, respectively, (total: 6.9 ± 1.5 mm) after the second scan (P < .01). No significant change in body weight (57.3 ± 12.6 vs. 56.7 ± 11.6 kg) or body mass index (21.8 ± 5.1 vs. 21.6 ± 4.8 kg/m²) was observed.ConclusionComputed tomography confirmed that diaphragm thickness was reduced in critically ill patients who underwent MV.     

Physical Activity,Quality of Life,and Burnout Among Physician Trainees: The Effect of a Team-Based,Incentivized Exercise Program

ObjectiveTo prospectively study the effects of an incentivized exercise program on physical activity (PA), quality of life (QOL), and burnout among residents and fellows (RFs) in a large academic medical center.Participants and MethodsIn January 2011, all RFs at Mayo Clinic in Rochester, Minnesota (N=1060), were invited to participate in an elective, team-based, 12-week, incentivized exercise program. Both participants and nonparticipants had access to the same institutional exercise facilities. Regardless of participation, all RFs were invited to complete baseline and follow-up (3-month) assessments of PA, QOL, and burnout.ResultsOf the 628 RFs who completed the baseline survey (59%), only 194 (31%) met the US Department of Health and Human Services recommendations for PA. Median reported QOL was 70 on a scale of 1 to 100, and 182 (29%) reported at least weekly burnout symptoms. A total of 245 individuals (23%) enrolled in the exercise program. No significant differences were found between program participants and nonparticipants with regard to baseline demographic characteristics, medical training level, PA, QOL, or burnout. At study completion, program participants were more likely than nonparticipants to meet the Department of Health and Human Services recommendations for exercise (48% vs 23%; P<.001). Quality of life was higher in program participants than in nonparticipants (median, 75 vs 68; P<.001). Burnout was lower in participants than in nonparticipants, although the difference was not statistically significant (24% vs 29%; P=.17).ConclusionA team-based, incentivized exercise program engaged 23% of RFs at our institution. After the program, participants had higher PA and QOL than nonparticipants who had equal exercise facility access. Residents and fellows may be much more sedentary than previously reported.     

Osteopathic manipulative treatment combined with exercise improves pain and disability in individuals with non-specific chronic neck pain: A pragmatic randomized controlled trial

PurposeTo determine effectiveness of osteopathic manipulative treatment combined with stretching and strengthening exercises in the cervical region on pain and disability in individuals with non-specific chronic neck pain.Methods90 adults with non-specific chronic neck pain were randomized to either exercises group (EG, n = 45) or osteopathic manipulative treatment associated with exercises group (OMT/EG, n = 45). The primary outcomes were obtained by the use of Numeric Pain-Rating Scale (NPRS), Pressure Pain Threshold (PPT) and Neck Disability Index (NDI). Secondary outcomes included range of motion (ROM) for cervical spine rotation, Fear-Avoidance Beliefs Questionnaire Work/Physical Activity (FABQ-W/PA) and Pain-self efficacy at two different moments: baseline and 4 weeks after the first treatment. Techniques and dosages of OMT were selected pragmatically by a registered osteopath. Generalized Estimating Equations model (GEE), complemented by the Least Significant Difference (LSD) and the intention-to-treat analysis, was used to assess the clinical outcomes.ResultsAnalysis with GEE indicated that OMT/EG reduced pain and disability more than the EG alone after 4 weeks of treatment with statistically significant difference (p < 0,05), as well as cervical active rotation was significantly improved (p = 0.03). There were no between-group differences observed in Pressure Pain Threshold (PPT) measure, Fear-Avoidance Beliefs Questionnaire and Pain-self efficacy.ConclusionThe association between OMT and exercises reduces pain and improves functional disability more than only exercise for individuals with non-specific chronic neck pain.