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[Post-dural puncture headache: risk factors, associated variables and interventions].
Mansutti, I, Bello, A, Calderini, AM, Valentinis, M
Assistenza infermieristica e ricerca : AIR. 2015;(3):134-41
Abstract
AIM: To identify nurses' doubts and questions (about lumbar puncture, related nursing interventions and post-dural puncture headache - PDPH) and to find answers in the available literature. METHODS 26 nurses were asked to identify open questions and a literature review was conducted searching on Medline, Cochrane database of Systematic Reviews and Cinahl. RESULTS Atraumatic needles, small gauge, cranial bevel oriented insertion and stylet reinsertion are variables that reduce the risk of PDPH. Bed rest has no efficacy in reducing this complication. On the contrary, it may increase the risk of PDPH. There are not enough evidences about the efficacy of additional fluid intake after the procedure. It's not clear if the risk of PDPH could be affected by the position during lumbar puncture and the volume of cerebrospinal fluid withdrawn. CONCLUSIONS This literature review clarifies some aspects of lumbar puncture and PDPH the use of traumatic or atraumatic needles, the bevel orientation and stylet reinsertion, bed rest. More research is needed to study the efficacy of other interventions, still uncertain (patient position during the procedure, volume of cerebrospinal fluid withdrawn, hydration and analgesic drugs' efficacy).
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[Decubitus or incontinence-associated dermatitis?].
Houwing, RH, Koopman, ES
Nederlands tijdschrift voor geneeskunde. 2014;:A7450
Abstract
A lack of understanding about the distinction between incontinence-associated dermatitis and pressure sores leads to inadequate treatment and therefore a higher incidence of pressure sores. Pressure relief may not be adequately carried out due to concentration exclusively on treatment of incontinence. In this article we will discuss the multifactorial approach, based on 2 patient cases. In order to prevent pressure sores, the cause of incontinence has to be investigated and treated if possible. Appropriate pressure relief must be carried out, in addition to adequate skin care.
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Bedrest and sarcopenia.
Coker, RH, Wolfe, RR
Current opinion in clinical nutrition and metabolic care. 2012;(1):7-11
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Abstract
PURPOSE OF REVIEW The primary focus of this review is to characterize the physiological elements of sarcopenia. In addition, we will also describe the impact of bedrest on sarcopenia and how various countermeasures may be able to offset the deleterious clinical consequences of unanticipated bedrest or hospitalization. It is well known that the aging process presents many challenges to the maintenance of overall health. With the increasing rate of obesity and the potentially simultaneous development of sarcopenia, bedrest presents a difficult clinical challenge to the elderly individual. RECENT FINDINGS The etiology of accelerated sarcopenia has been described as a syndrome. The characteristics of this syndrome include combined alterations in neuromuscular control and muscle protein synthesis that increase the risk of morbidity and mortality in the elderly population. Moreover, the acute onset of bedrest-induced insulin resistance may further complicate the nutritionally derived maintenance of muscle mass and physical function. SUMMARY Even though many questions remain unresolved concerning the optimal clinical management of elderly individuals who undergo unanticipated bedrest, the supplementation of essential amino acids has shown promise as a therapeutic strategy to minimize the detrimental influence of hospitalization in the elderly. In turn, this nutritional adjunctive therapy may reduce the length of stay and the likelihood of repeated hospitalization.
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[Space flight/bedrest immobilization and bone. Urolithiasis formation during space flight and long-term bed rest].
Kohri, K, Yasui, T, Okada, A
Clinical calcium. 2012;(12):1821-8
Abstract
Prior to human spaceflight the potential problems related to reduced gravitational forces on the musculoskeletal system were recognized, the extent and significance of the changes, however, were not known. Loss of bone mineral density has been a consistent finding after long-duration space flight and long-term bed rest. The main pathogenesis of calcium-urolithiasis is Western diet. Approximate 10% of urolithiasis is produced by bone mineral loss. We recently developed new treatment of bisphosphonate administration to preuent urolithiasis formation in both astronauts and recurrent urolithiasis patients with osteoporosis.This paper shows the results and basic research works.
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[Space flight/bedrest immobilization and bone. Bone metabolism in space flight and long-duration bed rest].
Ohshima, H, Matsumoto, T
Clinical calcium. 2012;(12):1803-12
Abstract
Bone loss and urolithiasis are inevitable outcome in human space flight and long-duration bet rest. The rate of space flight induced bone loss is 10 times faster than in those with osteoporosis. Significant bone loss at weight bearing bones, elevated urinary calcium excretion, and un-coupling of bone resorption and bone formation are observed during the long-term bed rest study. Improvements of resistive exercise device and vitamin-D supplementation for astronauts in International Space Station can partially maintain bone mass, however, they can not fully supress bone resorption and urinary calcium excretion during space flight. JAXA and NASA are performing joint study to validate the mitigration effects on bone resorption and urolithiasis of bisphosphonate supplement in conjunction with excercise.
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[Space flight/bedrest immobilization and bone. Space flight and bed rest-mediated muscle atrophy].
Ikeda, C, Abe, T, Sakai, A, Hirasaka, K, Nikawa, T
Clinical calcium. 2012;(12):1813-20
Abstract
Muscle atrophy caused by unloading stress is a challenging problem for bed-rested patients or astronauts. However, countermeasures against these muscle atrophy have not been developed yet. Under unloading conditions, skeletal muscle mass is rapidly lost by the increase in protein breakdown and the decrease in protein synthesis. It has been shown that this enhancement of proteolysis in atrophying muscles results mainly from activation of the ubiquitin-proteasome proteolytic pathway. Previous our studies revealed that unloading stress led to skeletal muscle atrophy through the induction of ubiquitin ligase, Cbl-b (Casitas B-lineage lymphoma b) expression. Thus, Cbl-b inhibiters may be potent therapeutic and preventive sources against skeletal muscle atrophy caused by unloading stress.
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[Space flight/bedrest immobilization and bone. Bisphosphonate and the loss of bone mineral due to space flight or prolonged bed rest].
Endo, I, Matsumoto, T
Clinical calcium. 2012;(12):1863-70
Abstract
Bone mass and strength are maintained by appropriate weight bearing. The loss of bone mineral due to space flight or prolonged bed rest has been recognized by space scientists and physicians. In spite of the wealth of knowledge obtained thus far, many questions remain unanswered regarding the mechanism of bone loss as well as the factors affecting these skeletal processes. Bisphosphonates have a potential to become countermeasures against space flight-induced or disuse osteoporosis. In this review, the effect and the possible role of biphosphonates on the prevention and treatment of unloading-induced osteoporosis are summarized and future prospects are discussed.
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[Kidney stone formation during space flight and long-term bed rest].
Okada, A, Ichikawa, J, Tozawa, K
Clinical calcium. 2011;(10):1505-10
Abstract
Microgravity environment like space flight or a condition requiring long-term bed-rest increase bone resorption and decrease bone formation, inducing the rapid decrease of bone minerals to osteoporosis. Bone mineral loss increases urinary calcium excretion and the risk of urinary stone formation. To clarify the influence of the conditions on renal stone formation, a 90-day bed rest test was performed to analyze the mechanism of microgravity or bed rest-induced stone formation and prevention by bisphosphonate medication and bed-rest exercise. As the results, renal stone formation was observed in control and exercise groups and no stone was seen in the medication group. In the medication group, urinary calcium excretion and relative supersaturation of calcium oxalate were lower than in the control group throughout the bed-rest and recovery period. Bisphosphonate is useful for the prevention of renal stone formation during space flight and long-term bed-rest.
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Lack of regular physical exercise or too much inactivity.
Thyfault, JP, Booth, FW
Current opinion in clinical nutrition and metabolic care. 2011;(4):374-8
Abstract
PURPOSE OF REVIEW To discuss the current data that acute periods of physical inactivity are harmful to health. RECENT FINDINGS Bed rest prescribed for recovery from clinical conditions causes changes in thousands of mRNAs in leg muscles within days. Humans genetically more susceptible to metabolic disorders (low birth weight babies and type 2 diabetic offspring) are as, or more, susceptible to further metabolic dysfunction by the environmental perturbation of bed rest, as compared with healthy controls without these risk factors. High daily accumulations of sitting are not only associated with enhanced metabolic risk, but current findings report that increased sitting time leads to a reduction in insulin sensitivity. Reductions in walking or in ambulatory activity (lower step numbers taken by healthy humans) reduce insulin sensitivity and insulin signaling through Akt in skeletal muscle. SUMMARY New findings using human models of physical inactivity (bed rest, increased sitting time, and reduced daily ambulatory activity), extend pre-existing research showing that transitioning to physical inactivity rapidly reduced metabolic health. Modern technological advances that remove standing, walking, and major limb movement initiate metabolic dysfunctions that likely play a fundamental role in the development of obesity and type 2 diabetes.
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Protecting muscle mass and function in older adults during bed rest.
English, KL, Paddon-Jones, D
Current opinion in clinical nutrition and metabolic care. 2010;(1):34-9
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Abstract
PURPOSE OF REVIEW To highlight the losses in muscle mass, strength, power, and functional capacity incurred in older adults during bed rest-mediated inactivity and to provide practical recommendations for both the prevention and rehabilitation of these losses. RECENT FINDINGS In addition to sarcopenic muscle loss, older adults lose lean tissue more rapidly than the young during prolonged periods of physical inactivity. Amino acid or protein supplementation has the potential to maintain muscle protein synthesis and may reduce inactivity-induced muscle loss, but should ideally be part of an integrated countermeasure regimen consisting of nutrition, exercise, and, when appropriate, pharmacologic interventions. SUMMARY In accordance with recent mechanistic advances, we recommend an applied, broad-based two-phase approach to limit inactivity-mediated losses of muscle mass and function in older adults: (i) Lifestyle: consume a moderate amount (25-30 g) of high-quality protein with each meal and incorporate habitual exercise in close temporal proximity to protein-containing meals; (ii) Crises: react aggressively to combat the accelerated loss of muscle mass and function during acute catabolic crises and periods of reduced physical activity. As a base strategy, this should include nutritional support such as targeted protein or amino acid supplementation and integrated physical therapy.