Notes

COVID-19: Provides social isolation lowered the particular engine performance associated with pollution from the megacity associated with São Paulo-Brazil?
We report a rare case in which a peripherally inserted central catheter (PICC) asymptomatically penetrated the median nerve. The patient was a 71-year-old man who displayed no neurological symptoms until 4 days after PICC placement. An ultrasound scan revealed that the PICC had penetrated the median nerve. He underwent surgery to remove the catheter and had no sequelae. When placing a PICC, selecting the brachial vein as a puncture site is associated with a high risk of nerve injury. Furthermore, circumspect observation is needed until withdrawal as neurological symptoms may be absent even when the catheter has punctured a nerve.We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. While SPG blockade has been used to treat headaches and provide perioperative analgesia, this complication and a possible mechanism have not been described. We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.Headache after subarachnoid hemorrhage and corresponding craniotomy with aneurysm clipping can be severe and difficult to treat. Currently accepted analgesic therapies are often ineffective at treating the pain without incurring unacceptable side effects. We present an innovative approach wherein intravenous lidocaine infusions were used to successfully treat 2 patients with hyperalgesia refractory to traditional analgesic therapies. Opioid consumption fell to zero for both patients during lidocaine infusions without lidocaine toxicity. Moreover, after discontinuation of lidocaine infusions, both patients reported good pain control using only standard oral medications.
The hamstrings (HS) muscle group plays a fundamental role in maintaining knee stability, thus contributing to the prevention and rehabilitation of lower limb musculoskeletal injuries. However, little is known about HS structural and functional adaptations after periods of prolonged inactivity. Our purpose was to investigate the HS morphological and contractile properties changes during 10 d of bed rest (BR).

Ten young healthy males underwent a 10-d BR. HS cross-sectional area (CSA) (at 30%, 50%, and 70% of femur length) and biceps femoris long head (BFlh) architecture were assessed by ultrasound imaging after 0 d (BR0), 2 d (BR2), 4 d (BR4), 6 d (BR6), and 10 d (BR10) of BR, whereas BFlh contractile properties (radial twitch displacement [Dm] and contraction time [Tc]) were evaluated at the same time points by tensiomyography. HS muscle volume was assessed by magnetic resonance imaging at BR0 and BR10.

A reduction in muscle volume was observed in BFlh ( P = 0.002; Δ = -3.53%), biceps femoris short head fascicle length were also observed, accompanied by alterations in BFLh contractile properties. These HS modifications should not be ignored from a clinical perspective.
Perceived control, an indicator of the patient's ability to cope and thrive with a chronic illness, is a common target of nursing interventions. As of 2019, more than 25 000 patients had been implanted with a left ventricular assist device (LVAD) as a treatment of advanced heart failure. Patients with an LVAD experience significant life changes that affect anxiety, depression, health-related quality of life, and, presumably, perceived control. To adequately intervene and improve perceived control, a reliable and valid measure is needed.

The objectives of this analysis were to (1) assess item discrimination and anticipated range of scores of the Control Attitudes Scale-Revised (CAS-R), (2) assess the internal consistency and validity of the CAS-R, and (3) examine perceived control in a sample of patients with an LVAD.

Two cohorts of patients with an LVAD (n = 113) were combined to evaluate the psychometric qualities of the CAS-R. Correlations among patient-reported outcomes and perceived control were used to evaluate validity. Cronbach α was used to test internal consistency. Item response theory was used to measure item discrimination and anticipated scores. Descriptive statistics describe perceived control in the sample.

Overall, the CAS-R demonstrated good internal consistency and convergent validity with other patient-reported outcomes. Using the item response theory, we saw that the CAS-R was a good predictor of lower-moderate scorers but was not good at differentiating high performers. There were several items that were poor discriminators and could be altered or discarded to create a more predictive instrument.

The CAS-R is a valid and reliable instrument to measure perceived control in patients who have LVAD implants; however, more work could be done to improve item-level information.
The CAS-R is a valid and reliable instrument to measure perceived control in patients who have LVAD implants; however, more work could be done to improve item-level information.
The COVID-19 pandemic raised concerns about the effects of stress on sleep and mental health, particularly among people with chronic conditions, including people with heart failure (HF).

The aim of this study was to examine changes in sleep, sleep-related cognitions, stress, anxiety, and depression among people with HF who participated in a randomized controlled trial of cognitive behavioral therapy for insomnia before the COVID-19 pandemic.

Participants self-reported sleep characteristics, symptoms, mood, and stress at baseline, 6 months after cognitive behavioral therapy for insomnia or HF self-management education (attention control), and during the pandemic.

The sample included 112 participants (mean age, 63 ± 12.9 years; 47% women; 13% Black; 68% New York Heart Association class II or III). Statistically significant improvements in sleep, stress, mood, and symptoms that occurred 6 months post treatment were sustained during the pandemic.

Improving sleep and symptoms among people with HF may improve coping during stressful events, and cognitive behavioral therapy for insomnia may be protective.
Improving sleep and symptoms among people with HF may improve coping during stressful events, and cognitive behavioral therapy for insomnia may be protective.
Individuals with heart failure (HF), a debilitating disease with ongoing adaptation and management, are often cared for by partner caregivers whose needs and voices are overshadowed by the demands of HF management. With multidimensional needs and complex challenges for individuals with HF, partner caregivers have to deal with uncertainty and need guidance. Given the vital role of partners, attention should be drawn toward understanding the experience of HF partner caregivers.

The aim of this study was to synthesize existing qualitative evidence related to caregivers' views and experiences of caring for their partners with HF. This knowledge would assist healthcare providers to better meet the demand of partners and provide them with effective guidance.

A meta-ethnography of qualitative evidence was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations for reporting systematic reviews. A comprehensive search of PubMed, Scopus, ISI Web of Science, CINAHL, PsycINF is strongly warranted to enhance caregivers' support and education. A deeper and more comprehensive understanding of the experiences of caregivers for partners with HF is essential for developing tailored interventions. Healthcare providers should be aware of the importance of ongoing assessment and evaluate partner caregivers' needs and assist them in providing more information and formulating coping strategies as required.
Given the complex roles in caring for individuals with HF, more qualitative research is strongly warranted to enhance caregivers' support and education. A deeper and more comprehensive understanding of the experiences of caregivers for partners with HF is essential for developing tailored interventions. Healthcare providers should be aware of the importance of ongoing assessment and evaluate partner caregivers' needs and assist them in providing more information and formulating coping strategies as required.
Adults with chronic low back pain, disability, moderate-to-severe pain, and high fear of movement and reinjury were recruited into a trial of a novel, automated, digital therapeutics, virtual reality, psychological intervention for pain (DTxP). We conducted a 3-arm, prospective, double-blind, pilot, randomized, controlled trial comparing DTxP with a sham placebo comparator and an open-label standard care. Participants were enrolled for 6 to 8 weeks, after which, the standard care control arm were rerandomized to receive either the DTxP or sham placebo. Forty-two participants completed assessments at baseline, immediately posttreatment (6-8 weeks), 9-week, and 5-month follow-up. We found that participants in the DTxP group reported greater reductions in fear of movement and better global impression of change when compared with sham placebo and standard care post treatment. No other group differences were noted at posttreatment or follow-up. When compared with baseline, participants in the DTxP group reportedevent in the sham placebo, which was not related to treatment. No substantial changes in medications were noted, and participants in the DTxP group reported positive gaming experiences.
Manual lymphatic drainage (MLD) is widely used in the treatment of breast cancer-related postmastectomy lymphedema (BCRL). However, the therapeutic benefit of MLD on BCRL remains controversial.

The aim of this study was to analyze the efficacy of MLD for BCRL.

Four electronic databases were systematically searched for trials comparing MLD and no MLD treatment as options for BCRL. Comparative treatment results included reduction of upper extremity limb volume with subgroup analysis by the number and duration of treatments.

A total of 457 patients were included in the analysis. There was no significant difference in the amount of upper extremity edema between the MLD treatment and control or no MLD groups (P = .11). However, when the treatment course was ≥20 sessions, there was a significant reduction in the upper extremity volume (P = .03). There was also a significant reduction in the upper extremity volume when treatment duration was >2 weeks (P = .03).

Manual lymphatic drainage treatment statistically did not reduce the upper extremity limb volume of BCRL, but upper extremity volume was reduced at statistically significant levels when treatment number were ≥20 sessions or the duration of treatment was >2 weeks.

Reduction in upper limb volume is dependent on the number and duration of treatments. When treatment number were ≥20 sessions, or the duration of treatment was >2 weeks, reduction of upper limb volume was statistically achieved. Manual lymphatic drainage treatment can be clinically recommended to treat BCRL according to these parameters.
2 weeks, reduction of upper limb volume was statistically achieved. Manual lymphatic drainage treatment can be clinically recommended to treat BCRL according to these parameters.
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