The effects of various respiratory physiotherapies after lung resection:a systematic review

PURPOSE: The purpose of this review was to investigate the effect of respiratory physiotherapy after lung resection on mortality, postoperative pulmonary complications (PPC), length of stay, lung volumes, and adverse events. MATERIAL AND METHODS: Randomized or quasi-randomized controlled trials were searched in CENTRAL, PubMed, EMBASE, Cinahl, PEDro, and hand searching of related studies. Various respiratory physiotherapy interventions were compared to standard care, sham treatment, or no treatment. Two reviewers assessed eligibility and quality of studies using Cochrane guidelines. Meta-analyses were undertaken on subgroups of intervention. RESULTS: Various types of positive pressure breathing, deep breathing exercises, and strength and aerobic exercises as a supplement to standard care did not show any significant effect over standard care in preventing mortality or PPC, reducing length of stay, or improving lung volumes. CONCLUSION: Prophylactic continuous positive airway pressure does not seem to affect rate of mortality and PPC, when compared with standard care embodying respiratory physiotherapy such as airway clearance techniques and assistance with early ambulation. However, further research is still needed to make a final conclusion. The effect of standard respiratory physiotherapy as a package is still unknown, and may or may not be effective in preventing PPC among patients undergoing lung resection

Physical inactivity is associated with chronic musculoskeletal complaints 11 years later: results from the Nord-Trøndelag Health Study

Background Physical inactivity is associated with several diseases, but studies evaluating the association between chronic musculoskeletal complaints (MSCs) and physical exercise have shown conflicting results. The aim of this large-scale prospective population-based study was to investigate the association between self-reported physical exercise at baseline and the prevalence of chronic musculoskeletal complaints (MSCs) 11 years later. Methods The results are based upon two consecutive public health studies conducted within the county of Nord-Trøndelag, Norway (The HUNT studies). A total of 39,520 (83%) out of 47,556 adults who participated in HUNT 1 and HUNT 2 responded to questions about physical exercise at baseline in 1984–86, and to questions about musculoskeletal complaints 11 years later (1995–97). Chronic MSCs was defined as MSCs ≥ 3 months during the past year, and chronic widespread MSCs such as pain ≥ 15 days during the last month from the axial region, above the waist, and below the waist. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR) with 95% confidence intervals (CIs). All the final analyses were adjusted for age, gender, body mass index, smoking and education level. Results At follow-up 20,223 (51%) reported chronic MSCs, and among these 2,318 (5.9%) reported chronic widespread MSCs. Individuals who exercised at baseline were less likely to report chronic MSCs 11 years later (OR 0.91, 95% CI 0.85–0.97) than inactive persons. Among individuals who exercised more than three times per week, chronic widespread MSCs were 28% less common (OR 0.72, 95% CI 0.59–0.88) compared to inactive individuals. Conclusion In this large-scale population-based study, physical exercise was associated with lower prevalence of chronic MSCs, in particular chronic widespread MSCs. Future studies should try to clarify whether chronic MSCs are a cause or a consequence of inactivity

To what extent do current total hip and knee replacement patient information resources adhere to enhanced recovery after surgery principles?

© 2018 Chartered Society of Physiotherapy Objectives: Total hip replacement (THR) and total knee replacement (TKR) are two of the most common orthopaedic surgeries that occur in the United Kingdom (UK) annually. Enhanced recovery after surgery (ERAS) programmes aim to decrease convalescence across procedures. It has been highlighted that post operative physiotherapy routines may not contain the correct ingredients for promoting acceleration of return to function. This research aims to analyse if current THR and TKR patient information resources adhere to ERAS principles, thus optimising post operative recovery. Data sources: Twenty hip and knee replacement patient information booklets were sourced using a UK Google search. A flowchart of exercise prescription components was formulated from a review of 5 trial booklets. A content analysis was utilised to assess the information included within the patient information booklets. Results: Forty percent of patient information booklets identified their pathways to be ERAS. Fifty five percent of the hospitals stated their patients would be mobilised on the day of surgery. Ninety percent of THR and 100% of TKR guidelines suggested the use of bed exercises for rehabilitation. Fifteen percent of THR and 35% of TKR booklets suggested functional exercise as a method of rehabilitation. Strength or resistance based exercises were proposed in 40% of THR and 55% of TKR booklets. Conclusion: Many patient information booklets do not follow ERAS principles for fast-track rehabilitation and the exercise prescription procedure is non-specific. This must be considered within post operative rehabilitation in order to enhance recovery and reduce length of stay following THR or TKR surgery

Erhvervsminister pynter på Tour’ens popularitet med usandsynligt høje seertal

status: publishe

Markovianity and Time Changed Lévy Processes

The objective of the thesis is to investigate Markov structures of time changed Lévy processes. Moreover we investigate the Markov structures of stochastic differential equations driven by Brownian motion with a view towards obtaining Markov structures of stochastic differential equations driven by time changed Brownian motion. The bulk of the thesis consists of four chapters. A chapter for preliminary material, and a chapter for each of the three themes, Markovianity, Lévy processes and time changed Lévy processes. The chapter on Markovianity deals with different equivalent definitions of the Markov property and states results on the finite dimensional distribution of a Markov process. The chapter on Lévy processes deals with the definitions of Lévy processes, the Lévy-Khintchine representation, and makes the connections between Lévy processes and Markov processes, showing that a Lévy process is a Markov process. The chapter on time changed processes deals, at first, with general time changed progressively meausurable stochatic processes. Here we are interested in showing that such processes are measurable. We present the well know result that a subordination process is a Markov process. Moreover we characterize time changed Lévy processes by the property of conditionally stationary independent increments. In this chapter we deal with two well-known time changed Lévy processes, namely the Normal inverse Gaussian distribution and the Cox process, also known as a doubly stochastic Poisson process. Moreover measuraility properties of the time changed Lévy process is studied, leading to different types of filtrations with respect to which the time changed Lévy process is measurable. With one of these fitrations it is possible to show a result, that is interesting in the study of Markovianity of time changed Lévy processes. Throughout the chapters we unfold results on the Markovianity of solutions to stochastic differential equations and present a result that shows that a solution to a stochastic differential equation driven by a Brownian motion time changed with a subordinator (the time process is a Lévy process) can be shown to exist and can be shown to be a Markov process. Moreover we introduce the case where the time change process is continuous