Factors Associated With Timing of Initiation of Physical Therapy in Patients With Acute Lung Injury.

Factors associated with timing of initiation of physical therapy in patients with acute lung injury.

J Crit Care. 2013 Jul 8;
Mendez-Tellez PA, Dinglas VD, Colantuoni E, Ciesla N, Sevransky JE, Shanholtz C, Pronovost PJ, Needham DM

Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation.A secondary analysis of a prospective cohort study was conducted.The study was conducted in 11 ICUs in 3 teaching hospitals.A total of 503 patients with ALI were included in the study.No interventions were used in this study.Thirty-four percent of patients ever received PT. In multivariable analysis, factors associated with later PT were a higher Sequential Organ Failure Assessment score (hazard ratio, 0.89; 95% confidence interval, 0.85-0.93), higher fraction of inspired oxygen (0.97, 0.96-0.98), mechanical ventilation (0.31, 0.16-0.59), coma (0.32, 0.20-0.51), delirium (0.72, 0.50-1.03), and continuous sedation (with daily sedation interruption: 0.49, 0.30-0.81; without daily sedation interruption: 0.59, 0.39-0.89). Factors associated with earlier PT were an admitting diagnosis of trauma (3.31, 1.74-6.31) and hospital study site (2.84, 1.89-4.26).In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation. HubMed – rehab

Allogenous tooth fragment reattachment.

BMJ Case Rep. 2013; 2013(jul10_1):
Maitin N, Maitin S, Rastogi K, Bhushan R

Coronal fractures of the anterior teeth are a common form of dental trauma and its sequelae may impair the establishment and accomplishment of an adequate treatment plan. Among the various treatment options, reattachment of a crown fragment obtained from a previously extracted tooth is a conservative treatment that should be considered for crown fractures of anterior teeth. This article reports reattachment of an allogenous tooth fragment in a fractured maxillary lateral incisor in a 38-year-old patient. It is suggested that allogenous reattachment in a fractured anterior tooth serves to be a better alternative and should be further researched. Aesthetic and functional rehabilitation of a fractured complicated anterior crown using allogenous tooth fragment is a better alternative to other more conventional treatment options. HubMed – rehab