1. Cardiac rehabilitation aims to optimize a cardiac patient's physical, psychological, and social functioning through medical, exercise, educational, and psychosocial interventions.
2. It is divided into 4 phases - the acute hospitalization phase focuses on early mobilization; phase 2 occurs post-discharge and focuses on health education and resuming activity; phase 3 incorporates ongoing education and exercise training; and phase 4 focuses on long-term lifestyle changes and monitoring.
3. Exercise prescription for cardiac patients follows general principles but is adjusted based on each patient's clinical status and risk factors. Intensity is progressed over time from low to moderate levels based on symptoms.
What does cardiac rehab involve? Cardiac rehabilitation doesn't change your past, but it can help you improve your heart's future. Cardiac rehab is a medically supervised program designed to improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery.
Cardiac Rehabilitation has been defined as:
Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community
What does cardiac rehab involve? Cardiac rehabilitation doesn't change your past, but it can help you improve your heart's future. Cardiac rehab is a medically supervised program designed to improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery.
Cardiac Rehabilitation has been defined as:
Coordinated, multifaceted interventions designed to optimize a cardiac patient’s physical, psychological, and social functioning so that they may, by their own efforts, resume and maintain as normal a place as possible in the community
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
this power point presentation provides main emphasis on the phases of the rehabilitation post op. it will enhance the knowledge about do's and dont's during the rehabilitation phases in brief. U may ask the questions if you have in your mind in the comment section. this ppt includes upper extremity as well as lower extremity exercises and also provides easy understanding with the help of suitable and intresting diagrams
Definition, epidemiology, physiology, effects of physical inactivity, benefits of habitual physical activity, contraindications, phases, physical assessment, exercise sessions, description of cardiac rehabilitation program phase II @ University Hospital University of Puerto Rico School of Medicine
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
Glimpse of Cardiac rehabilitation for health care professionals to update themselves, with aim of helping people with or without disease. Focus on primary, secondary, tertiary prevention.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient tailored therapies that include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors”
this power point presentation provides main emphasis on the phases of the rehabilitation post op. it will enhance the knowledge about do's and dont's during the rehabilitation phases in brief. U may ask the questions if you have in your mind in the comment section. this ppt includes upper extremity as well as lower extremity exercises and also provides easy understanding with the help of suitable and intresting diagrams
Definition, epidemiology, physiology, effects of physical inactivity, benefits of habitual physical activity, contraindications, phases, physical assessment, exercise sessions, description of cardiac rehabilitation program phase II @ University Hospital University of Puerto Rico School of Medicine
A treadmill exercise stress test is used to determine the effects of exercise on the heart. Exercise allows doctors to detect abnormal heart rhythms (arrhythmias) and diagnose the presence or absence of coronary artery disease.
This test involves walking in place on a treadmill while monitoring the electrical activity of your heart. Throughout the test, the speed and incline of the treadmill increase. The results show how well your heart responds to the stress of different levels of exercise.
Description
A technologist will explain the test to you, take a brief medical history, and answer any questions you may have. Your blood pressure, heart rate, and electrocardiogram (ECG) will be monitored before, during, and after the test.
You will be asked to sign a consent form. This form is required before the test can proceed.
You will be asked to remove all upper body clothing, and to put on a gown with the opening to the front.
Adhesive electrodes will be put onto your chest to capture an ECG. The sites where the electrodes are placed will be cleaned with alcohol and shaved if necessary. A mild abrasion may also be used to ensure a good quality ECG recording.
Your resting blood pressure, heart rate, and ECG will be recorded.
You will be asked to walk on a treadmill. The walk starts off slowly, then the speed and incline increases at set times. It is very important that you walk as long as possible because the test is effort-dependent.
You will be monitored throughout the test. If a problem occurs, the technologist will stop the test right away. It is very important for you to tell the technologist if you experience any symptoms, such as chest pain, dizziness, unusual shortness of breath, or extreme fatigue.
Following the test, you will be asked to lie down. Your blood pressure, heart rate, and ECG will be monitored for three to five minutes after exercise.
The data will be reviewed by a cardiologist after the test is completed. A report will be sent to the doctor(s) involved in your care.
Exercise tolerance testing (also known as exercise testing or exercise stress testing) is used routinely in evaluating patients who present with chest pain, in patients who have chest pain on exertion, and in patients with known ischaemic heart disease.
Glimpse of Cardiac rehabilitation for health care professionals to update themselves, with aim of helping people with or without disease. Focus on primary, secondary, tertiary prevention.
The Clinical Pharmacist in Cardiac Rehabilitation Phase I at Sarawak General ...guestaf1e4
A Health Related Quality of Life Study in Patients with Acute Coronary Syndromes: The Cost-Effectiveness of Clinical Pharmacy Service in the Phase I, and Short Course Phase II Cardiac Rehabilitation Program
Authors of proposal: 1, 2 Professor Dr. Sim Kui Hian, 4 Professor Dr. Mohd. Izham Mohd Ibrahim, 1, 2 Dr. Alan Fong Yean Yip, 3 Yanti Nasyuhana Sani, 3 Tiong Lee Len, 3 Bibi Faridha Mohd Salleh, 4 Dr Mohd. Azmi Ahmad Hassali, 4 Prof. Dr Yahaya Hassan, 3 Lawrence Anchah, 5 Karen Tang Siew Lang, 1 Hii Ai Ching,1 Sii Lik Ngoh
1 Dept of Cardiology, Sarawak General Hospital.
2 Clinical Research Centre, Sarawak General Hospital.
3 Dept of Pharmacy, Sarawak General Hospital.
4 School Pharmaceutical Sciences, Universiti Sains Malaysia.
5 Dept of Physiotherapy, Sarawak General Hospital.
NIH Reference No.: (4) dlm.KKM/NIHSEC/08/0804/P07-161, dated 3rd September 2007
Completed 20th Dec 2009
Researcher: Lawrence Anak Ancah, B. Pharm, M. Clinical Pharm, Candidate for Ph.D Cinical Pharmacy in Cardiovascular & HRQoL
Catdiac Rehabilitation and phases of cardiac rehabilitation gurusardaar
it includes description of cardiac rehabilitation with its phases in hospital and post hospital care and physiotherapy management of cardiac patients with follow up this includes introduction indications contraindications with four phases of cardiac rehabilitation in this ppt u will get everything to know about the cardiac rehabilitation and advancements in cardiac rehabilitation
Exercise Prescription for Cardiac Patientsnihal Ashraf
Cardiovascular disease (CVD) is the leading cause of death and a major cause of disability worldwide. (WHO., 2003)
Cardiac rehabilitation is the process of restoring psychological, physical and social function in the people with manifestations of coronary artery disease( CAD).
Cardiac rehabilitation is a branch of rehabilitation medicine or physical therapy dealing with optimizing physical function in patients with cardiac disease or recent cardiac surgeries.
cardiac rehab program may include exercises like cycling on a stationary bike, using a treadmill, low-impact aerobics, and swimming.
Cardiac rehab may benefit you if you have:
Cardiovascular disease
Had a recent cardiac event, such as a heart attack
Heart failure
Had a cardiac procedure, such as angioplasty or heart surgery
An arrhythmia (abnormal heart rhythm) or an implantable device (for example, pacemaker or defibrillator).
Have you ever wondered about the life expectancy after experiencing a cardiac arrest?
Cardiac arrest is a sudden and often fatal condition, leaving many wondering if survival is even possible.
In this article, we will delve into the factors that contribute to life expectancy after cardiac arrest, including medical advancements, emergency response times, and the importance of post-arrest care.
Join us as we explore this intriguing topic and shed light on the potential for a fulfilling, post-cardiac arrest life.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. Dr. Vinod K. Ravaliya, MPT
Cardiothoracic Physiotherapy
Shree Krishna Hospital
KMPIP, Karamsad
2. Definition
Members of CR
Benefits of CR
Assessment of risk factors and system-wise
examination
Phases of CR
Principles of exercise program for cardiac
patients
4. Introduction
Up until the 1950s, strict bed rest was
thought to be the best medicine after a heart
attack.
Following discharge moderately stressful
activity such as climbing stairs was
discouraged for a year or more.
5. "The patient is to be guarded by day and night
nursing and helped in every way to avoid
voluntary movement or effort."
Thomas Lewis, 1933
6. Cardiac rehabilitation has been defined as
The sum of activities required to ensure
cardiac patients the best possible physical,
mental and social conditions so that they may,
by their own efforts, resume and maintain as
normal a place as possible in the community.
Cardiac rehabilitation has also been described as
The combined and coordinated use of
medical, psychosocial, educational, vocational
and physical measures to facilitate return to an
active and satisfying lifestyle.
7. The Coordinated, multifaceted interventions
designed to optimize a cardiac patient’s
physicial, psychological, and social functioning,
in addition to stabilizing, slowing or even
reversing the progression of the underlying
atherosclerotic process, thereby reducing
morbidity and mortality
AHA Scientific Statement, Circ 2005;111:369-76
8. Post-MI
Post-CABG
Angina
PCI
Valve replacement or repair
Heart transplant
Indications for CHF continue to be evaluated
9. Offset deleterious pyschologic and physiologic
effects of bed rest during hospitalization
Provide additional medical surveillance of patients
Enable patients to return to activities of daily living
within the limits imposed by their disease
Prepare the patient and the support system at
home to optimize recovery followed by hospital
discharge
HM734 Exercise Testing and Prescription: Cardiorespiratory 9
10. Reduces cardiovascular and total mortality
Does not increase non-fatal reinfarction rate
Improves myocardial perfusion
May reduce progression of atherosclerosis
when combined with aggressive diet
No consistent effects on hemodynamics, LV
function or visible collaterals
11. No consistent effects on cardiac arrhythmias
Improves exercise tolerance without
significant CV complications
Improves skeletal muscle strength and
endurance in clinically stable patients
Promotes favorable exercise habits
Decreases angina and CHF symptoms
12. 1. Smoking cessation
2. Lipid management
3. Weight control
4. Blood pressure control
5. Improved exercise tolerance
6. Symptom control
7. Return to work
8. Psychological well-being/stress management
13. A Cochrane review in 2004 concluded that exercise
only cardiac rehabilitation reduced all cause mortality
by 27% and cardiac mortality by 31%
The Canadian Co-ordinating Office for Health
Technology Assessment reported reductions of all
cause mortality of 24% and cardiac mortality of 23%.
A study by Witt et al in 2004 found that not only was
participation in cardiac rehab associated with
decreased mortality after MI but also with lower risk
of recurrent MI
14. Clinical risk stratification is suitable for low to
moderate risk patients undergoing low to
moderate intensity exercise
Exercise testing and echocardiography are
recommended for high risk patients and/or high
intensity exercise
Functional exercise capacity should be
evaluated before and on completion of exercise
training.
16. Exercise capacity
Quality of life surveys (SF-12, SF-36)
BP
Weight
Waist circumference
Lipids
Glucose/HbA1C
Telemetry monitoring occurs during exercise
sessions
Nutritional survey tool
Stress level
17.
18. Absolute Acute myocardial infarction (within two days)
Unstable angina
Uncontrolled cardiac arrhythmias causing symptoms or homodynamic
compromise
Symptomatic severe aortic stenosis
Uncontrolled symptomatic heart failure
Acute pulmonary embolus or pulmonary infarction
Acute myocarditis or pericarditis
Active endocarditis
Acute aortic dissection
Acute noncardiac disorder that may affect exercise performance or be
aggravated by exercise
Inability to obtain consent
Exercise standards for testing and training: a statement for healthcare professionals
from the American Heart Association. Circulation 2001; 104:1694
19. Left main coronary stenosis or its equivalent
Moderate stenotic valvular heart disease
Electrolyte abnormalities
Severe hypertension (systolic 200 mmHg and/or diastolic 110 mmHg)
Tachyarrhythmias or bradyarrhythmias, including atrial fibrillation with
uncontrolled ventricular rate
Hypertrophic cardiomyopathy and other forms of outflow tract
obstruction
Mental or physical impairment leading to inability to cooperate
High-degree atrioventricular block
Exercise standards for testing and training: a statement for healthcare professionals
from the American Heart Association. Circulation 2001; 104:1694;
20.
21. Conditioning from acute event/ post-CABG
To make patient functionally independent
To adjust with discharge from the hospital
Psychological counselling
Nutritional counselling
Secondary prevention targetting
22. Phase I relates to the period of
hospitalization following an acute cardiac
event. The duration of this phase may vary
depending on the initial diagnosis, the
severity of the event and individual
institutions, usually one week acute
event/post-operative.
23. During this phase,
Early mobilization and adequate discharge
planning.
Individuals typically undergo a risk factor
assessment and risk stratification
Receiving information regarding their diagnosis,
risk factors, medications and work/ social issues.
Involvement and support of the partner and
family is facilitated and encouraged.
24.
25. Functional goals
– Exercise training under supervision/ at
home
Psychosocial goals
– Anxiety/depression management
Secondary preventive targets
26. Phase II: This phase encompasses the
Immediate post discharge period, which is typically a
period of four to six weeks.
It focuses on
health education and
resumption of physical activity, however the structure of this
phase may vary dramatically from centre to centre.
It may take the format of
telephone follow up,
home visits, or
individual or group education sessions.
Either way, some form of contact is maintained with the
patient, facilitating ongoing education and exchange of
information.
27.
28. Functional goals
– Exercise training under supervision
Psychosocial goals
– Return to work
– Return to hobbies and lifestyle
– Anxiety/depression management
Secondary preventive targets
29. Phase III: This phase is sometimes erroneously
referred to as the ‘Exercise’ phase.
It incorporates
Exercise training in combination with ongoing
education and psychosocial and vocational
interventions.
The duration of Phase 3 may vary from six to 12
weeks, with patients required to attend a CR unit two
to three times weekly for structured exercise and
other lifestyle interventions.
30.
31. Maintenance of achieved functional status
Return to work
– Return to hobbies and lifestyle
modifications
Secondary preventive targets
32. Phase IV: This phase constitutes the components
of long-term maintenance of lifestyle changes
and professional monitoring of clinical status.
It is when patients leave the structured Phase 3
programme and continue exercise and other
lifestyle modifications indefinitely.
This may be facilitated in the CR unit itself or in a
local leisure centre.
Alternatively, individuals may prefer to exercise
independently and
Phase 4 may involve helping them set a safe and
realistic maintenance programme.
33.
34. Frequency
Early mobilization:
▪ 3-4 times/day (days 1-3)
Later mobilization:
▪ 2 times/day (beginning on day 4)
Progression:
Initially increase duration up to 10-15 min, then
increase intensity.
HM734 Exercise Testing and Prescription: Cardiorespiratory 34
35. By hospital discharge, the patient should:
Demonstrate a knowledge of inappropriate
exercises
Have a safe, progressive plan of exercise
formulated for them to take home
HM734 Exercise Testing and Prescription: Cardiorespiratory 35
36. Selected moderate to high risk patients
should be encouraged to participate in
outpatient cardiac rehabilitation programs
&/or
Manage their discharge rehabilitation plan
and report any cardiovascular symptoms
promptly (should they occur).
HM734 Exercise Testing and Prescription: Cardiorespiratory 36
37. Goals are to:
Provide appropriate patient monitoring and
supervision to detect a deterioration in clinical
status and to provide timely feedback to the
referring physician to enhance effective medical
feedback,
Contingent upon patient clinical status, return
patient to pre-morbid vocational &/or recreational
activities, modify or find alternative activities,
HM734 Exercise Testing and Prescription: Cardiorespiratory 37
38. Goals are to:
Develop and help the patient to establish and
implement a safe and effective home exercise
program and recreational lifestyle,
Provide patient and family education and
therapies to maximize secondary prevention.
HM734 Exercise Testing and Prescription: Cardiorespiratory 38
39. In general, patients should engage in multiple
activities to promote total conditioning
including aerobic and resistance exercises.
Principles of prescription are those for
healthy adults but adjusted to take into
account the patients clinical status.
HM734 Exercise Testing and Prescription: Cardiorespiratory 39
40. Use of RPE. Particularly useful when GXT has
not been performed or medications change.
Normally 11-13 (fairly light to somewhat hard)
for Phase II.
Later (Phase III or IV) may use 12-15
(Approximately 60-80% VO2R
HM734 Exercise Testing and Prescription: Cardiorespiratory 40
41. RPE can be used with beta-blockers BUT
Should remember that significant and serious
ST segment and/or arrhythmias can still occur
at low intensities and RPE’s
HM734 Exercise Testing and Prescription: Cardiorespiratory 41
42. Some patients: need to know when
abnormalities occur to enable exercise below
anginal or ischemic threshold
Use of HR monitor with alarms
Peak exercise HR 10 bpm below appropriate
threshold.
Need to allow for medication effects on
exercise tolerance and HR.
HM734 Exercise Testing and Prescription: Cardiorespiratory 42
43. Signs and symptoms below which an upper limit for
exercise should be set:
Onset of angina or other symptoms of CV insufficiency
Plateau or decrease in SBP, SBP > 240 or DBP > 110
mmHg.
1mm ST-segment depression
Increasing frequency of ventricular arrhythmias
Other significant ECG changes
Other signs or symptoms of intolerance to exercise
HM734 Exercise Testing and Prescription: Cardiorespiratory 43
44. Desire to have 20-60 min of continuous or
intermittent activity
Inversely proportional to intensity
May be able to accumulate in short (10-15
min) bouts.
HM734 Exercise Testing and Prescription: Cardiorespiratory 44
45. Depends upon patient functional capacity and
prognosis
Generally, progress over 3-6 months to 1000
kcal/week
Follow principles of initial, conditioning and
maintenance phase
Generally progress every 1-3 weeks with goal of
achieving 20-30 min of continuous exercise.
HM734 Exercise Testing and Prescription: Cardiorespiratory 45
46. Patients requiring intermittent program (eg.
Peripheral vascular disease, low functional
capacity) should progress according to
symptoms and clinical status
HM734 Exercise Testing and Prescription: Cardiorespiratory 46
47. Functional capacity 8 METS or twice
occupational level
Appropriate hemodynamic response to exercise
Appropriate ECG response
Adequate management of risk factor
intervention strategy and safe exercise
participation
Demonstrated knowledge of disease process,
abnormal signs and symptoms, medication use
and side effects
HM734 Exercise Testing and Prescription: Cardiorespiratory 47
48. Initial intensities determined according to
length of time from acute cardiac event and
associated complications, duration since
discharge and patient information (ADL’s
current home program, associated signs and
symptoms)
Use of Duke Activity Status Index
HM734 Exercise Testing and Prescription: Cardiorespiratory 48
49. Previously required abstinence from
resistance training for several months post
MI.
Now many patients can start by carrying up
to 13 kg by 3 weeks post MI.
Generally use approx. 50% 1RM or use of
other modes such as bands, hand weights
etc. in Phase II.
HM734 Exercise Testing and Prescription: Cardiorespiratory 49
50. Should not begin until 2-3 weeks post MI.
After 4-6 weeks post MI, may start bar bells
and/or weight machines
Note: surgical patients need to adjust
program to accommodate sternotomy
Normally begin resistance program 2-3 weeks
after initiating aerobic program.
HM734 Exercise Testing and Prescription: Cardiorespiratory 50
51. Advocate 1 set of 8-10 different exercises that
focus on large muscle groups, 2-3 days/week.
Will result in significant improvements
Additional sets/reps do not seem to result in
substantial improvements.
HM734 Exercise Testing and Prescription: Cardiorespiratory 51
52. Initially start with 1 set of 10-15 reps to moderate
fatigue using 8-10 different exercises
Increase 1-2 kg/week for arms and 3-5 kg/week for
legs.
Check rate, pressure product. Shouldn’t exceed
that for endurance exercise
RPE: 11-14.
Avoid Valsalva
HM734 Exercise Testing and Prescription: Cardiorespiratory 52
53. Initially start with 1 set of 10-15 reps to moderate
fatigue using 8-10 different exercises
Increase 1-2 kg/week for arms and 3-5 kg/week for
legs.
Check rate, pressure product. Shouldn’t exceed
that for endurance exercise
RPE: 11-14.
Avoid Valsalva
HM734 Exercise Testing and Prescription: Cardiorespiratory 53