Burden of an educational program on end of life management in a Internal Medicine ward: a real life report.

BACKGROUND AND AIM: Appropriate end of life (EOL) management in Internal Medicine wards is challanging. The aim of this study was to analyze the burden of an educational program on EOL management in a Internal Medicine ward. Materials and methods: We retrospectively analysed characteristics and management of patients consecutively died in an italian Internal Medicine ward along one year. We compared demographic, co-morbidity, pharmacological treatment in the last 48-hours of life and procedures during hospital stay in patients died six months before and after an educational program on palliative cares and EOL management addressed to a team of physicians and nurses. RESULTS: Study population was composed by 354 patients (190 females), with mean age ± DS 83.5 ± 10.6 years, one half admitted after the educational program. Eighty-four percent of deaths was exepected in the last 48 hours before exitus. Demographic characteristics and causes of hospitalization were not different before and after educational program. After the educational program the sharing of palliative care program with patient, relatives and/or caregivers (97.7% vs 85.8%, p=0.0001) and written order to withdrawal vital parameters relevation (39.5% vs 22%, p=0.0005) significantly increased, while difference in pharmacological classes prescribed in the last 48 hours of life was not find. Blood (54.8% vs 67.2%, p=0.0219) and arterial gas analysis (28.8% vs 39.5%, p=0.0435) samples in the last 48 hours of life were significantly reduced. Radiological and/or endoscopic examinations, red cells or platelets transfusion were reduced and palliative therapy was increased, despite difference between the two periods was not statistically significant. CONCLUSION: Educational program in Internal Medicine wards aimed to improve skills could contribute to make EOL management more appropriate and patient-oriented and it should be strongly encour-aged.

Efectos Inmediatos de la Técnica de Manipulación de Ashmore C5/C6 en la Actividad Muscular, en pacientes con Cervicalgia Mecánica / Immediate Effects of the Ashmore Manipulation Technique C5/C6, in Muscle Activity in patients with Mechanical Neck Pain

Introducción: La manipulación vertebral se relaciona con el aumento de la fuerza muscular, aunque no existen suficientes evidencias relativas a su aplicación en el raquis cervical. Objetivo: Determinar los efectos inmediatos de la técnica de manipulación de C5/C6 (Ashmore) en la actividad electromiográfica en reposo y en las contracciones del músculo deltoides medio bilateralmente. Material y Métodos: Estudio experimental, aleatorizado, cegado y controlado. Treinta (n=30) pacientes con Cervicalgia Mecánica (CM) se distribuyeron aleatoriamente en dos grupos, experimental (GE; n=15) y control (GC; n=15). Los pacientes fueron evaluados mediante el cuestionario Neck Disability Index (NDI), el test de la arteria vertebral y electromiografía (EMG) antes de la intervención. Después de las intervenciones en los grupos de estudio, realizamos otra vez la prueba EMG. Resultados: Los análisis comparativos intergrupos post-intervención presentaron diferencias estadísticamente significativas para las variables Root Mean Square (RMS) en isometría de 30 segundos bilateral, para el músculo deltoides medio. Conclusiones: La manipulación vertebral C5-C6 disminuye la actividad electromiográfica en la contracción isométrica, pero no produce cambios electromiográficos en reposo ni en contracción isotónica (AU)

Introduction: The effects of spinal manipulation are not yet entirely clear. Previous studies have found both increased and decreased electromyographic (EMG) activity of muscles related to the level being manipulated, although few of them have considered the cervical region or symptomatic individuals. Objetives: To determine the immediate effects of the C5/C6 (Ashmore) manipulation technique on bilateral EMG activity of the middle deltoid muscle at rest and in contractions. Patients, Materials and Methods: A randomized, controlled, single blind, experimental study was conducted. A total of 30 individuals presenting with mechanical neck pain were assigned randomly to two groups: 15 formed the experimental group (EG), and 15 the control group (CG). All participants completed a data questionnaire and the NDI (Neck Disability Index), and underwent a vertebral artery and EMG evaluation before their participation. After C5/C6 manipulation in the intervention group and no manipulation in the control group, the EMG evaluation was repeated. Results: All the variables were normally distributed, indicative of the total sample's initial homogeneity. Comparative post-intervention inter-group analyses showed statistically significant differences in the root mean square (RMS) values of the 30-s isometric bilateral EMG measurements of the middle deltoid muscle's activity. Conclusions: C5-C6 spinal manipulation reduced EMG activity in the longer isometric contractions, but no changes were observed neither in the resting EMG values nor in the isotonic contractions performed(AU)