乳腺癌患者术后不同卧位及早期功能锻炼舒适程度的观察

目的探讨舒适护理在乳腺癌患者手术后早期的应用效果。方法对乳腺癌患者在手术后6b内给予舒适卧位及患侧上肢早期定时功能锻炼，并评价其效果。结果全身麻醉手术后非去枕平卧位及给予早期患侧上肢功能锻炼可以提高乳腺癌患者手术后的舒适程度，有利于患者术后机体功能的恢复。结论乳腺癌患者手术后早期实施舒适卧位及适度的患侧上肢功能锻炼可以促进功能恢复并提高舒适程度，减少术后并发症的发生。     

中西医结合健康教育在干预抑郁症复发中的作用

目的对抑郁症患者进行规律的为期3年的中西医结合健康教育,并与未进行健康教育的患者对照,以探讨中西医结合健康教育在干预抑郁症复发和康复方面的作用。方法采用以中西医理论为基础的健康教育方式,对56例抑郁症患者在住院期间及痊愈出院后定期干预3年,住院期间主要在每日查房时和个别心理治疗中穿插进行,患者家属探视和出院时对患者家属进行健康教育。出院后要求患者半年内每月复诊1次,0.5～1.5年,3个月复诊1次,1.5年后6个月复诊1次,在复诊时强化院内健康教育内容,以及针对患者心理变化,遇到的心理问题社会问题进行健康教育,干预其复发。另设42例进行常规药物及心理治疗的患者作为对照,疗程结束后比较两组复发率及相关因素。结果研究组和对照组复发率比较差异有显著性意义(χ2=18.971,P<0.01)。研究组与对照组比较,其服药依从性比较(χ2=19.717,P<0.01),SDSS评分比较(t=5.724,P<0.01),差异均有显著性意义。自杀发生率研究组4%,对照组17%,(χ2=4.929,P<0.05)研究组低于对照组。结论中西医结合健康教育可以有效干预抑郁症复发。     

控制图原理及在传染病预警中的应用现状

在传染病发生的早期阶段做出预警,可及时采取干预措施,尽可能降低传染病对人类健康和对社会经济、政治等的影响.控制图法是一种简单易行且功效高的预警技术,但也有不足之处.     

Gastric Ultrasound: POCUSing an Intolerant GUT!

How to cite this article: Kothekar AT, Joshi AV. Gastric Ultrasound: POCUSing an Intolerant GUT! Indian J Crit Care Med 2022;26(9):981–982.     

Programmatic adaptations to acute malnutrition screening and treatment during the COVID‐19 pandemic

The COVID‐19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community‐based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid‐upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow‐up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners'' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well‐accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID‐19 disruptions; however, challenges included long‐term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers'' need to travel. Concerns remained about how adaptations impacted children''s identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi‐year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations'' impacts, including how to ensure equity and mitigate unintended consequences.     

Opportunities for Earlier Diagnosis and Treatment of Cardiac Amyloidosis

Despite the rapid expansion of noninvasive (nonbiopsy) diagnosis, contemporary patients with cardiac amyloidosis too often present with advanced features of disease, such as diminished quality of life, elevated natriuretic peptides, and advanced heart failure. Therapeutics for transthyretin cardiomyopathy (ATTR-CM) are most effective when administered before significant symptoms of cardiac dysfunction manifest, making early identification of affected individuals of paramount importance. Community engagement and ensuring that a broad range of clinicians have working knowledge of how to screen for ATTR-CM in everyday practice will be an important step in moving disease identification further upstream. However, reliance on the appropriate and timely diagnosis by individual clinicians may continue to underperform. This review highlights how targeted screening of special populations may facilitate earlier diagnosis. Systems of care that operationalize screening of high-risk subpopulations and prospective validation of novel approaches to ATTR-CM identification are needed.     

The Effect of Harsh Environmental Conditions on Concrete Plastic Shrinkage Cracks: Case Study Saudi Arabia

Due to climate change and population expansion, concrete structures are progressively being subjected to more extreme environments. As the environment affects plastic shrinkage directly, there is a need to understand the effect of environmental changes on plastic shrinkage cracking. This paper examines the plastic shrinkage crack development parametrically at low, mid, and high drying environmental conditions, corresponding to different environments in three Saudi cities. The effects of water-cement ratios and quantities of recycled tire steel fibers (RTSF) in concrete are also investigated. The different environmental conditions for the plastic shrinkage tests were simulated in a specially designed chamber as per ASTM C1579, 2006. A digital image processing (DIP) technique was used to monitor crack initiation and development. Through the use of the crack reduction ratio (CRR), it was found that 30 kg/m³ of RTSF can control plastic shrinkage cracks at low and mid conditions. For the more extreme (high) conditions, the use of 40 kg/m³ of RTSF fiber was sufficient to completely eliminate surface plastic shrinkage cracks. This work can help develop more sustainable concrete structures in a wider set of environmental conditions and help mitigate the impact of climate change on concrete infrastructure.     

Ancillary treatment of patients with lung disease due to non-tuberculous mycobacteria: a narrative review

Background and ObjectiveNon-tuberculous mycobacterial lung disease (NTM-LD) manifests with bronchiectasis, inflammatory bronchiolitis, nodules, and/or cavitation. Bronchiectasis is characterized by permanently dilated airways wherein mucus accumulates, creating a vicious cycle of chronic injurious inflammation and recurrent infections. While antibiotics are an important part of the treatment of NTM-LD, airway clearance techniques to mitigate this pathogenic mechanism of bronchiectasis as well as other ancillary measures are also important components of NTM-LD treatment. The objective of this contemporaneous Narrative Review is to emphasize the importance of such ancillary measures.MethodsWe searched PubMed for the key words of “airway clearance”, “pulmonary rehabilitation”, “nutrition”, “swallowing dysfunction”, “gastroesophageal reflux”, “vestibular dysfunction”, or “cochlear dysfunction” with that of “non-tuberculous mycobacterial lung disease”, “bronchiectasis”, or “respiratory disease”. The bibliographies of identified articles were further searched for relevant articles not previously identified. Each relevant article was reviewed by one or more of the authors and a narrative review was composed.Key Content and FindingsHerein, we discuss five ancillary treatment measures that are pertinent to patients with bronchiectasis and NTM-LD: (I) airway clearance; (II) physical and pulmonary rehabilitation; (III) nutrition; (IV) diagnosis and mitigation of swallowing dysfunction and of gastroesophageal reflux disease (GERD); and (V) minimization of vestibular and cochlear dysfunction associated with some anti-NTM drugs.ConclusionsWhile antibiotics is often the central focus of treatment of NTM-LD, given its propensity for recurrent and recalcitrant infection, other ancillary measures to break the vicious cycle of injurious inflammation and infection should also be emphasized to optimize treatment success.