Move it or lose it? A survey of the aims of treatment when using passive movements in intensive care.

OBJECTIVES: To identify the aims of treatment when physiotherapists use passive movements (PMs) for ventilated and sedated patients on intensive care in the UK. METHOD: Postal questionnaires distributed to senior physiotherapists working within all National Health Service (NHS) trusts with open level 3 ICU beds. Open questionnaire items surveyed the aims of using PMs in different clinical areas (neurology, cardiology, orthopaedics/trauma, general surgery, medicine, other). RESULTS: The vast majority of respondents stated that the aim of using PMs was to maintain joint range of movement (ROM) in ventilated and sedated patients across all clinical areas. Respondents also identified additional uses of PMs for neurological patients. CONCLUSION: There appears to be a high level of consensus amongst physiotherapists that PMs influence joint range and that there will be a loss of range if PMs are not carried out. Currently this is not supported by empirical evidence. Therefore, future research should investigate the actual physiological effects of PMs and the clinical reasoning underpinning their use in critically ill patients.

Diabetic colon preparation comparison study.

The purpose of the present study was to establish an optimal colon preparation for persons with diabetes who are undergoing colonoscopies. Specifically, the aim was to compare the difference between an experimental and standard preparation. Adequacy of bowel preparation is critical for good bowel visualization. Compared with nondiabetic patients, persons with diabetes have slower gastric emptying, colonic transit, and colon evacuation. Inadequate preparations may lead to suboptimal colonoscopy resulting in overlooked pathology, repeated examinations with associated risks, and organizational inefficiencies. Using a single-blind experimental design, 198 persons with diabetes who were scheduled to receive colonoscopies were randomly assigned to either the experimental (diabetic colon preparation) or the control (standard colon preparation) group. Patients in the diabetic colon preparation group had 70% good colon preparations compared with 54% in the standard group, and this finding was significant (χ = 5.14, p = 0.02). Results indicate that diabetic patients receiving 10 ounces of magnesium citrate 2 days prior to their colonoscopies followed by 10 ounces of magnesium citrate and 4-L polyethylene glycol the day prior to the procedure had cleaner colons than those receiving standard preparation of 10 ounces of magnesium citrate and 4-L polyethylene glycol the day prior to procedure. This colon preparation is safe, feasible, well-tolerated, and effective.

Department of Health Research Initiative on Nutrition Phase 2: overview of findings and recommendations.

OBJECTIVE: The purpose of this overview is to synthesise and summarise the findings and recommendations of all 14 projects funded between 1997 and 2002 under Phase 2 of the Department of Health's Policy Research Programme Nutrition Initiative. This is aimed at end users, including policy makers, practitioners, researchers and research funding bodies. DESIGN: The main findings and recommendations for policy and practice, as well as for future research, contained in the peer-reviewed final report of each project are summarised under headings identified as being useful for policy groups and practitioners: Maintenance of a healthy weight; Functional outcomes related to different markers of iron status; Nutritional aspects of bone health in humans; and Dietary interventions. RESULTS: The overview draws together the key findings and recommendations for current and future policy and practice from the second phase of the research programme and identifies research gaps. CONCLUSIONS: The findings and recommendations of the Department of Health's Nutrition Research Initiative have contributed to the scientific evidence base for policy development, policy evaluation, and will inform practitioners as well as researchers and research funding bodies.