Knowledge on types of treatment pressure. A cross-sectional study among mental health professionals

Treatment pressure restricts patients' voluntary and autonomous decisions. Yet interventions involving treatment pressure are widely used in mental health and psychosocial services. This cross-sectional study explored whether mental health professionals' knowledge on five types of treatment pressure (no coercion, persuasion or conviction, leverage, threat, and formal coercion) was associated with sociodemographic, professional and contextual factors. A more positive attitude towards interventions involving treatment pressure was associated with underrating the level of those interventions compared with a predefined default value. The treatment setting and professional group played a minor role in ‘leverage’ and ‘formal coercion’ types of treatment pressure, respectively.     

High Intensity Positive Pressure Ventilation and Long Term Pulmonary Function Responses in Severe Stable COPD. A Delicate and Difficult Balance

Method to improve minute ventilation (MV) during spontaneous breathing (SB) in stable severe chronic obstructive pulmonary disease (COPD) have a great clinical relevant in long term outcome. In this scenario, recommendations of early use of high-Intensity non-invasive Positive pressure Ventilation (HI-NPPV) or intelligent Volume Assured Pressure (iVAP) Support in Hypercapnic COPD have been proposed by safe therapeutics options. We analyze in this letter, Ekkernkamp et al. study that described the effect of HI-NPPV compared with SB on MV in patients receiving long-term treatment. We consider that interpretation of relationships between ABG, functional parameters, and respiratory mechanics reported need clarifications. Further prospective large clinical trials identifying the best mode of ventilation according to the characteristics in severe stable COPD are necessary to balance an effective approach and response on clinical symptoms and long-term effects.     

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??Objective??To select the best predictor of swallowing functions by exploring the correlation between the swallowing function and tongue mobility and tongue pressure of the patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery. Methods??From July 2017 to March 2018??in Hospital of Stomatology??Sun Yat-sen University??thirty-six cases of patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery were collected during return visits in the outpatient clinics of our hospital. The swallowing functions were graded by their water swallowing test??WST??results. The tongue mobility scores were evaluated by using the lingual range of motion??LROM??method??while the tongue pressure was measured by using the Iowa oral performance instrument??IOPI??. Spearman rank correlation analysis was applied to calculate the rank correlation coefficient??rs?? between the tongue mobility scores or tongue pressure and WST results??and the corresponding P value. Results??The rs value between WST results and tongue mobility scores or tongue pressure was -0.575 and -0.613 respectively??P??0.05??. The rs value of tongue pressure was larger than that of tongue mobility scores. Conclusion??Both the tongue mobility scores and tongue pressure have a great impact on the swallowing functions of patients with tongue defects after oral cancer surgery or oropharyngeal cancer surgery??and tongue pressure is the best predictor.     

Differences in ambulatory blood pressure profiles between Japanese and Thai patients with hypertension /suspected hypertension

Ethnic differences in the profiles of hypertension and cardiovascular risk have been reported between Asians and Westerners. However, blood pressure (BP) profiles and the risk factors for cardiovascular disease might differ even among different Asian populations because of the diversity of cultures, foods, and environments. We retrospectively examined differences in 24‐h BP profiles between 1051 Japanese (mean age, 62.5 ± 12.4 years; medicated hypertension, 75.7%) and 804 Thai (mean age, 56.9 ± 18.5 years; medicated hypertension, 65.6%) by using the Japanese and Thai ambulatory BP monitoring (ABPM) databases, in order to check the BP control status in treated hypertensives and to inform the clinical diagnosis of hypertension. The two populations had similar office systolic BP (SBP) (142.7 ± 20.0 vs 142.3 ± 20.6 mm Hg, p = .679). However, the Japanese population had higher 24‐hr average and daytime SBP, and the Thai population had higher nighttime SBP even after adjusting for cardiovascular risk factors (all p < .05). Greater morning BP surge was observed in Japanese (31.2 vs 22.8 mm Hg, p < .001). Regarding nocturnal BP dipping status, the prevalence of riser status (higher nighttime than daytime SBP) was higher in the Thai population (30.5% vs 10.9%). These findings suggest that a substantial difference in 24‐hr BP profiles exists between even neighboring countries in Asia.     

Novel combination Combining J-VAC® and VAC® sponge for draining a rectal wound

Active drains, which work by negative pressure, require a closed space for retaining the vacuum. Here the authors describe their novel technique of combining a J-Vac® drain and the sponge of a vacuum assisted closure dressing pack to drain a rectal wound. This modification may be useful for rectal wounds and anastomotic leaks.     

A single session of hatha yoga improves stress reactivity and recovery after an acute psychological stress task—A counterbalanced,randomized-crossover trial in healthy individuals

ObjectivesYoga is promoted as an anti-stress activity, however, little is known about the mechanisms through which it acts. The present study investigated the acute effects of a hatha yoga session, displayed on a video, on the response to and recovery from an acute psychological stressor.MethodsTwenty-four healthy young adults took part in a counterbalanced, randomized-crossover trial, with a yoga and a control condition (watching TV). Participants attended the laboratory in the afternoon on two days and each session comprised a baseline, control or yoga task, stress task and recovery. Blood pressure (BP), heart rate (HR) and salivary cortisol responses were measured. State cognitive- and somatic-anxiety along with self-confidence were assessed before and after the stressor.ResultsAlthough no difference in the BP or HR responses to stress were found between conditions, systolic BP (p = 0.047) and diastolic BP (p = 0.018) recovery from stress were significantly accelerated and salivary cortisol reactivity was significantly lower (p = 0.01) in the yoga condition. A yoga session also increased self-confidence (p = 0.006) in preparation for the task and after completion. Moreover, self-confidence reported after the stress task was considered debilitative towards performance in the control condition, but remained facilitative in the yoga condition.ConclusionOur results show that a single video-instructed session of hatha yoga was able to improve stress reactivity and recovery from an acute stress task in healthy individuals. These positive preliminary findings encourage further investigation in at-risk populations in which the magnitude of effects may be greater, and support the use of yoga for stress reactivity and recovery.     

微创肺表面活性物质及无创持续性气道压力在低体重早产儿呼吸窘迫综合征治疗中的应用

目的探讨微创肺表面活性物质(LISA)及无创持续性气道压力(ncpap)在低体重早产儿呼吸窘迫综合征(NRDS)治疗中的应用效果。方法回顾性选取2019年1月至2020年12月中山市博爱医院新生儿科收治的50例NRDS低体重早产儿为研究对象,根据治疗方案分为研究组(ncpap+LISA,n=22)和对照组(ncpap,n=28)。比较两组疗效、无创通气时间、住院时间、并发症发生率、治疗前、治疗1 d的血气分析等指标。结果研究组治疗总有效率高于对照组(95.45%vs.67.86%),而无创通气时间[(3.52±1.12)d vs.(4.36±1.39)d]、住院时间[(17.21±2.65)d vs.(19.87±3.43)d]则低于对照组(P0.05)。两组的并发症发生率比较,差异无统计学意义(P0.05)。与同组治疗前比较,两组治疗1 d的血氧分压(PaO_2)、pH值均升高,而同期氧合指数(OI)、二氧化碳分压(PaCO_2)均降低(P0.05)。研究组治疗1 d的PaO_2、pH值均高于对照组,而同期OI、PaCO_2则均低于对照组(P0.05)。结论 LISA及ncpap联合应用于低体重早产儿NRDS治疗中可改善疗效和缺氧状况,缩短无创通气时间并促进患儿康复,且安全可靠。     

A survey of protective cushion usage in individuals with spinal cord injury while traveling in a motor vehicle and on a commercial airliner

Abstract

Objective

While there are specific recommendations for pressure relieving cushions when seated in a wheelchair, there is a paucity of information regarding prescribed wheelchair cushions for persons with spinal cord injury (SCI) when traveling and not in their wheelchair seat. A questionnaire was designed to ascertain if individuals with SCI who are primarily wheelchair users utilize a prescribed wheelchair cushion when traveling in a motor vehicle (MV) or on a commercial airliner, as not utilizing one may be a causative factor in developing pressure ulcers.

Design and setting

Survey design in an outpatient SCI rehabilitation setting.

Participants

Full-time wheelchair users, with chronic (>1 year) SCI.

Results

Forty-two participants completed the survey, with a mean age of 39 years old and time post-injury of 10.4 years. All subjects used a prescribed wheelchair cushion when seated in their wheelchair. Twenty-seven subjects reported transferring to a MV seat (59.5% of sample), with 25 (92.6%) reporting not using a prescribed wheelchair cushion when sitting directly on the MV seat. For subjects who traveled on an airplane (n = 23–54.8%), 19 (82.6%) reported that they do not sit on a prescribed specialty cushion.

Conclusion

Persons with chronic SCI, who are primary wheelchair users, utilize prescribed wheelchair cushions when sitting in their wheelchair, but most do not utilize a prescribed wheelchair cushion when seated in a MV (if they transfer out of their chair) or on a airplane seat. Studies to determine the pressures over the bony prominences on their travel surfaces may need to be undertaken to see whether the pressures are appropriate, as they may be a source of skin breakdown.