Preoperative muscle weakness as defined by handgrip strength and postoperative outcomes: a systematic review

<p>Abstract</p> <p>Background</p> <p>Reduced muscle strength- commonly characterized by decreased handgrip strength compared to population norms- is associated with numerous untoward outcomes. Preoperative handgrip strength is a potentially attractive real-time, non-invasive, cheap and easy-to-perform "bedside" assessment tool. Using systematic review procedure, we investigated whether preoperative handgrip strength was associated with postoperative outcomes in adults undergoing surgery.</p> <p>Methods</p> <p>PRISMA and MOOSE consensus guidelines for reporting systematic reviews were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Clinical Trials (1980-2010) were systematically searched by two independent reviewers. The selection criteria were limited to include studies of preoperative handgrip strength in human adults undergoing non-emergency, cardiac and non-cardiac surgery. Study procedural quality was analysed using the Newcastle-Ottawa Quality Assessment score. The outcomes assessed were postoperative morbidity, mortality and hospital stay.</p> <p>Results</p> <p>Nineteen clinical studies (17 prospective; 4 in urgent surgery) comprising 2194 patients were identified between1980-2010. Impaired handgrip strength and postoperative morbidity were defined inconsistently between studies. Only 2 studies explicitly ensured investigators collecting postoperative outcomes data were blinded to preoperative handgrip strength test results. The heterogeneity of study design used and the diversity of surgical procedures precluded formal meta-analysis. Despite the moderate quality of these observational studies, lower handgrip strength was associated with increased morbidity (n = 10 studies), mortality (n = 2/5 studies) and length of hospital stay (n = 3/7 studies).</p> <p>Conclusions</p> <p>Impaired preoperative handgrip strength may be associated with poorer postoperative outcomes, but further work exploring its predictive power is warranted using prospectively acquired, objectively defined measures of postoperative morbidity.</p

Distorted body representations are robust to differences in experimental instructions

Several recent reports have shown that even healthy adults maintain highly distorted representations of the size and shape of their body. These distortions have been shown to be highly consistent across different study designs and dependent measures. However, previous studies have found that visual judgments of size can be modulated by the experimental instructions used, for example, by asking for judgments of the participant’s subjective experience of stimulus size (i.e., apparent instructions) versus judgments of actual stimulus properties (i.e., objective instructions). Previous studies investigating internal body representations have relied exclusively on ‘apparent’ instructions. Here, we investigated whether apparent versus objective instructions modulate findings of distorted body representations underlying position sense (Exp. 1), tactile distance perception (Exp. 2), as well as the conscious body image (Exp. 3). Our results replicate the characteristic distortions previously reported for each of these tasks and further show that these distortions are not affected by instruction type (i.e., apparent vs. objective). These results show that the distortions measured with these paradigms are robust to differences in instructions and do not reflect a dissociation between perception and belief

Using online modules to build capacity for teacher resilience

Teacher resilience is regarded as a complex, multidimensional, dynamic construct. Enhancing teacher resilience can potentially increase teacher commitment, yet interventions to build resilience in pre-service programmes are scarce. This chapter examines the effectiveness of the BRiTE (Building Resilience in Teacher Education) online modules to develop pre-service teachers\u27 capacity for resilience in Australia. The modules are briefly described. Perceptions of 146 final year pre-service teachers were gathered regarding resilience, self-efficacy, commitment and coping before completing the BRiTE modules and their final professional experience school placement. Both pre- and post-school placement measures were completed by 49 participants. To determine the impact of using the modules, matched data sets were divided with users (n = 32) scoring significantly higher scores than non-users (n = 17) on five post-placement survey scales. Despite some limitations, there was an indication that using the online modules assisted pre-service teachers develop their capacity for resilience. Adapting the modules for use with in-service teachers and other professionals is an avenue for future research. This study has significance, given the importance of teacher professional resilience, and suggests that interventions developed for pre-service contexts can make a difference

Nutritional therapy in the management of physical frailty and sarcopenia

reason, and being potentially modifiable disordersconditions, to find a strategy to prevent or improve these conditions is of great importance in cirrhotic patients. To date, there are no standardized treatments to reverse or prevent the deterioration of nutritional status and physical frailty in patients with liver cirrhosis. However, nutritional intervention and individual counseling to achieve adequate amounts of calories and proteins are recommended. Oral nutritional supplementations with BCAA or leucine or beta-hydroxy-beta-methyl butyrate combined with exercise training are promising measures, but more studies are needed to define the best way and time to operate with these approaches