Longitudinal evaluation the pulmonary function of the pre and postoperative periods in the coronary artery bypass graft surgery of patients treated with a physiotherapy protocol

<p>Abstract</p> <p>Background</p> <p>The treatment of coronary artery disease (CAD) seeks to reduce or prevent its complications and decrease morbidity and mortality. For certain subgroups of patients, coronary artery bypass graft surgery (CABG) may accomplish these goals. The objective of this study was to assess the pulmonary function in the CABG postoperative period of patients treated with a physiotherapy protocol.</p> <p>Methods</p> <p>Forty-two volunteers with an average age of 63 ± 2 years were included and separated into three groups: healthy volunteers (n = 09), patients with CAD (n = 9) and patients who underwent CABG (n = 20). Patients from the CABG group received preoperative and postoperative evaluations on days 3, 6, 15 and 30. Patients from the CAD group had evaluations on days 1 and 30 of the study, and the healthy volunteers were evaluated on day 1. Pulmonary function was evaluated by measuring forced vital capacity (FVC), maximum expiratory pressure (MEP) and Maximum inspiratory pressure (MIP).</p> <p>Results</p> <p>After CABG, there was a significant decrease in pulmonary function (p < 0.05), which was the worst on postoperative day 3 and returned to the preoperative baseline on postoperative day 30.</p> <p>Conclusion</p> <p>Pulmonary function decreased after CABG. Pulmonary function was the worst on postoperative day 3 and began to improve on postoperative day 15. Pulmonary function returned to the preoperative baseline on postoperative day 30.</p

Therapeutic Validity and Effectiveness of Preoperative Exercise on Functional Recovery after Joint Replacement: A Systematic Review and Meta-Analysis

Background: Our aim was to develop a rating scale to assess the therapeutic validity of therapeutic exercise programmes. By use of this rating scale we investigated the therapeutic validity of therapeutic exercise in patients awaiting primary total joint replacement (TJR). Finally, we studied the association between therapeutic validity of preoperative therapeutic exercise and its effectiveness in terms of postoperative functional recovery. Methods: (Quasi) randomised clinical trials on preoperative therapeutic exercise in adults awaiting TJR on postoperative recovery of functioning within three months after surgery were identified through database and reference screening. Two reviewers extracted data and assessed the risk of bias and therapeutic validity. Therapeutic validity of the interventions was assessed with a nine-itemed, expert-based rating scale (scores range from 0 to 9; score ≥6 reflecting therapeutic validity), developed in a four-round Delphi study. Effects were pooled using a random-effects model and meta-regression was used to study the influence of therapeutic validity. Results: Of the 7,492 articles retrieved, 12 studies (737 patients) were included. None of the included studies demonstrated therapeutic validity and two demonstrated low risk of bias. Therapeutic exercise was not associated with 1) observed functional recovery during the hospital stay (Standardised Mean Difference [SMD]: −1.19; 95%-confidence interval [CI], −2.46 to 0.08); 2) observed recovery within three months of surgery (SMD: −0.15; 95%-CI, −0.42 to 0.12); and 3) self-reported recovery within three months of surgery (SMD −0.07; 95%-CI, −0.35 to 0.21) compared with control participants. Meta-regression showed no statistically significant relationship between therapeutic validity and pooled-effects. Conclusion: Preoperative therapeutic exercise for TJR did not demonstrate beneficial effects on postoperative functional recovery. However, poor therapeutic validity of the therapeutic exercise programmes may have hampered potentially beneficial effects, since none of the studies met the predetermined quality criteria. Future review studies on therapeutic exercise should address therapeutic validity. (aut.ref.

Aquatische milieucriteria voor papierchemicalien

Doel van de studie was het ontwikkelen van milieucriteria voor het aquatische milieu, die gebruikt kunnen worden voor de beoordeling van papierchemicalien in het kader van de wet milieu gevaarlijke stoffen (WMS). Met deze criteria kan in de voorloopfase van notificatie een oordeel gegeven worden over het mogelijke risico voor het aquatisch milieu. De milieucriteria moeten gebaseerd zijn op het geaccepteerd risicobeleid van het Directoraat-Generaal Milieubeheer (DGM) en op in de Europese Gemeenschap geaccepteerde risicobeoordelingsmethodieken (TGD, 1996). De milieucriteria hebben betrekking op parameters die belangrijk zijn voor de emissieschatting (functiecategorie en specifieke fysisch-chemische eigenschappen) en een acute toxiciteitswaarde voor waterorganismen. Een 'standaardscenario' bestaande uit een vast tonnage (10 ton per jaar), Henri constante, octanol-water verdelingscoefficient, en vaste toxiciteits waarden voor waterorganimsen, werd gebruikt voor de afleiding van de criteria. De criteria werden toegepast op 28 in Nederland kennisgegeven papierchemicalien (tot december 1996). Indien de goed en niet-goed afbreekbare papierchemicalien samengevoegd werden, correspondeerde de klasse-indeling volgens de milieucriteria met de PEC/PNEC-ratio voor waterorganismen berekend in USES 1.0 met default instellingen volgens de TGD (1996). De milieucriteria kunnen samengevat worden in eenvoudige tabellen, die eenvoudig toepasbaar zijn voor fabrikanten en beleidsmedewerkers zonder gebruik te hoeven maken van een computer systeem.The aim of this study was the development of aquatic environmental criteria that can be used for the assessment of paper chemicals within the scope of The Chemical Substances Act. With these criteria a prediction on the possible risk for the aquatic environment can be given in the preliminary stage of notification. The criteria should be based on the accepted risk policy of the Directorate-General for Environmental Protection (DGM) and the accepted European Union risk assessment methods (TGD, 1996). The aquatic environmental criteria pertain to parameters which are important for the estimation of emissions (function category and specific physical-chemical properties) and an acute aquatic toxicity value. A 'standard scenario' which includes a fixed tonnage level (10 t.p.a), Henry's law constant, octanol-water partition coefficient and fixed aquatic toxicity values was used for the derivation of the criteria. The criteria were applied to 28 paper chemicals notified in the Netherlands up to December 1996. Taking together the readily and non-readily degradable paper chemicals, the classes following the environmental criteria corresponded with the PEC/PNEC ratio for the aquatic environment calculated by USES 1.0 adapted to TGD (1996) for all life cycle stages. The aquatic environmental criteria can be summarised in simple tables which can be easily applied by notifiers and policy makers without the use of a computer system.DGM/SV