ABSTRACT
BACKGROUND: Management of patients in intensive care units (ICUs) needs staff with a recommended level of expertise and experience owing to the life-threatening nature of illnesses, injuries and complications that these patients present with. There are no specific guidelines governing physiotherapy practice in ICUs in Nigeria. Hence, there is a need to have expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs as a first step to proposing/developing guidelines in the future. OBJECTIVES: To assess the expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs in Nigeria. METHODS: Physiotherapists with working experience in Nigerian ICUs were purposively recruited into the present study using a modified Delphi technique. A questionnaire comprising 222 question items on the role of physiotherapy in critical care was adopted and administered to the participants over three rounds of Delphi procedure (online). Participants checked either 'essential', 'not essential' or 'unsure' for each question item. For each question item to be considered 'essential' or 'not essential', a consensus agreement ≥70% had to be met. Questions without consensus were further modified by providing definition or clarification and presented in subsequent rounds. Data were analysed descriptively. RESULTS: We recruited 26 expert physiotherapists who consented to the study and completed the first round of the study. The majority of the physiotherapists (n=24) remained in the study after the third round. A total of 178 question items were adjudged to be 'essential' after the first round, and a further 15 and three additional items were subsequently adjudged to be as 'essential' after modifying the outstanding question items during the second and third rounds, respectively. No consensus was reached for 24 items. None of the question items were ranked as 'not essential' after all the rounds. CONCLUSION: Expert consensus was achieved for a substantial number of question items regarding knowledge and skills for assessment, condition and treatment items of the questionnaire by experienced critical care physiotherapists in Nigeria.
ABSTRACT
Caffeine is known to confer neuro-protection via A1 and A2A adenosine receptor antagonism in which adenosine neuro-modulates excitotoxic release of glutamate. Currently, it is unclear whether caffeine modulates inflammation in ischaemic stroke model. The present study examined effects of caffeine following ischaemia-reperfusion injury on neuro-inflammatory tumour necrosis alpha (TNF-α), lactate dehydrogenase (LDH), as well as effect of caffeine against brain ischaemic damage on histology. Thirty three adult male Wistar rats (180-300 g) were used in this study. They were randomly divided into four groups (n=5 each): Group I (Control) that received neither the operation nor any treatment; Group II (Sham/Water) received a pseudo-ischaemic-reperfusion and 1ml water for injection; Group III (BCCO/Water) that received complete bilateral common carotid occlusion (BCCO) and 1ml water for injection; Group IV (BCCO/Caffeine) that received complete BCCO and caffeine solution intraperitoneally at a dose of 50% LD50 value (144mg/kg); and thirteen rats were used for LD50 assessment. Sensory and motor functions significantly (p<0.05) decreased in the rat following ischaemia-reperfusion injury when compared to pre-injury state on Garcia neurological score. Caffeine reduced brain ischaemic injury and significantly reduced (p<0.05) TNF-α activity. While no significant effects (p>0.05) of caffeine was observed on LDH activity. This study has shown neuro-protective roles of caffeine against ischaemia-reperfusion damage to brain tissue, inflammatory TNF-α activity, but not on LDH activity.
