Mind the gap: diastasis of the rectus abdominis muscles in pregnant and postnatal women.

This article looks at the abdominal physiology of pregnant and postnatal women, the incidence of diastasis recti abdominis and the possible risk factors for this condition. The longer-term implications of this condition, the effects of exercise, indicators for referral and future pregnancies are discussed. Key practice points and resources for midwives and women are offered.

Innovative care model for patients with complex muscle diseases.

PURPOSE OF REVIEW: Many neuromuscular disorders require complex multisystem management. This is especially true for the rapidly growing numbers of young adults surviving congenital and childhood onset conditions following improved multidisciplinary care and the routine use of home ventilation. Surveys from the United Kingdom and Netherlands indicate that neuromuscular disorder patients report their services to be at best 'average' and more often 'poor' in quality. Centralization of care to a small number of specialist centres to increase critical mass and thus improve the expertise of clinical teams has been recommended. RECENT FINDINGS: A recent audit of unplanned hospital admissions for neuromuscular disorder patients has substantiated data from patient surveys. Patients often had no access to a neuromuscular specialist or had fragmented care; 37.5% of 359 unplanned neuromuscular disorder emergency admissions were identified as potentially avoidable. SUMMARY: A Neuromuscular Complex Care Centre has recently opened in the United Kingdom to provide holistic patient-centred care in a purpose built adapted environment with high staff to patient ratio. Elective multisystem assessments will be co-ordinated into a 'one stop' admission, bringing the specialists to the patient. The centre will provide first point of contact with 24-h telephone access 7 days a week and will advise and support local hospitals on the management of acutely unwell patients. Regular multidisciplinary meetings of specialized consultants and therapists will improve communication and maximize outcomes. In the long term, we anticipate this high-quality development to be cost-effective in reducing the frequency of outpatient appointments and emergency/critical care admissions.

Early presentation of very long chain acyl-CoA dehydrogenase deficiency: nursing action resulting in a positive outcome.

A clinical case of very long chain fatty acid acyl-CoA dehydrogenase (VLCAD) deficiency with cardiac manifestation, is presented. A 2-day old newborn, delivered after a normal pregnancy, birth, and immediate post-natal period, was transported from an outside hospital (OSH) with episodic wide complex tachycardia. In this case, the newborn screen returned suggesting VLCAD deficiency, positively redirecting treatment. An overview of VLCAD, one category of inborn error of metabolism (IEM), is presented. Additionally, the importance of newborn screening, the role of genetic testing, and nursing implications to improve outcomes, will also be discussed.

Skeletal muscle and genetics.

The regulation of hypertrophy or atrophy of skeletal muscle is highly regulated by genetic signals closely tied to function. This chapter focuses on the genetic alteration of structural and cytoskeletal proteins that influence exercise capacity, self-care, and activities of daily living by modulation of the physiologic cross-sectional area of skeletal muscle. In addition to a discussion of genetic mechanisms of atrophy and sarcopenia, the muscular dystrophies along with the laminopathies, both diseases of cytoskeletal proteins will be reviewed.

Critical illness polyneuromyopathy (CIPNM); rehabilitation during critical illness. Therapeutic options in nursing to promote recovery: a review of the literature.

Following critical illness requiring prolonged mechanical ventilation and sedation, intensive care patients often present with neuromuscular weakness. This results from critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). A lack of diagnostic criteria for each syndrome complicates prevention and treatment. Consequently the term critical illness polyneuromyopathy (CIPNM) has emerged and is characterised by severe weakness, reduced or absent limb reflexes and marked muscle wasting. Although clinical trials report a high incidence of CIPNM, in clinical practice it often remains undetected. The pathophysiological mechanisms that lead to neuromuscular weakness are not entirely clear, however several risk factors have been identified and will be discussed. To date, there are no specific treatments or interventions available to reduce the onset or impact of CIPNM. This paper will review the strategies employed that are supportive and aimed at controlling the associated risk factors.

Idoso com sarcopenia: uma abordagem do cuidado da enfermeira / Aged with Sarcopenia: an approach of nursing care / Edoso com Sarcopenia: una abordaje del cuidado de la enfermera

No processo do envelhecimento vão ocorrendo perdas orgânicas e funcionais, cujo ritmo e intensidade variam de pessoa para pessoa, e que acabam por diminuir a capacidade que cada indivíduo tem para adaptar-se ao meio ambiente tornando-o exposto e vulnerável a processos patológicos levando-o a um declínio físico natural. Dores e disfunções no sistema músculo-esquelético constituem freqüente queixa e incapacidade na velhice. Esse fato é compreensível, já que muitas das doenças desse sistema têm maior incidência com o avançar da idade, ao lado de outras que são quase que exclusivas dessa população, e são doenças crônicas não fatais com freqüência cumulativa, umas predispondo as outras. Neste contexto se situa a responsabilidade da atenção e do cuidado ao idoso com sarcopenia, cabendo a enfermagem como integrante de uma equipe interdisciplinar, envidar esforços para atuar na prevenção, orientação, supervisão e administração da assistência.

In the grow old process organic and functional damages happening, wich rhythm and intensity change from person to person and that finish to reduce the ability from each person has to adapt the environment, making more visible and vulnerable to illness process,that are the perturbation produced in the body by the illness taking the person to a natural physical decline. Pain and disorders in the muscle skeletal system are the most frequent complain in the old age and the second cause of inability in this group.This fact is comprehensible now that many diseases of the muscle skeletal system have more incidence with the advance of age, beside others that are almost exclusive of these population and are chronic illness, not deadly with cumulative frequence ones predisposing the others. Is in this context that is situated the responsability of the attention and care of the older with sarcopenia , having to the nursing like member of a interdisciplinar group , make efforts to act in the prevention, guidance, supervision and management of the assistance.

Durante el proceso de envejecimiento ocurren perdidas organicas y funcionales, cuyo ritmo y intensidad varian de persona para persona acabando por diminuir la capacidad que cada individuo tiene en adaptarse al medio ambiente, tornandolo expuesto y vulnerable a procesos patologicos llevandolo a un declinio fisico natural. Dolores y disfunciones en el sistema musculo esqueletico constituen frecuente queja y incapacidad en la vejez.Este factor es comprensible visto que varias enfermedades de ese sistema tienen mayor incidencia con el avanzo de la edad, al lado de otras que son casi que exclusivas de esta populacion y son casi siempre, enfermades cronicas no fatales con frequencia cumulativa, unas predisponiendo a las otras. Neste contexto se situa la responsabilidad de la atención y del cuidado a la populación edosa, cabiendo al enfermero como integrante de una euipe interdisciplinar, constituir esfuerzos en el sentido de actuar en la prevención, orientación, supervisión y administración de la asistencia.

[Aged with sarcopenia: an approach of nursing care]. / Idoso com sarcopenia: uma abordagem do cuidado da enfermeira.

In the grow old process organic and functional damages happening, wich rhythm and intensity change from person to person and that finish to reduce the ability from each person has to adapt the environment, making more visible and vulnerable to illness process, that are the perturbation produced in the body by the illness taking the person to a natural physical decline. Pain and disorders in the muscle skeletal system are the most frequent complain in the old age and the second cause of inability in this group. This fact is comprehensible now that many diseases of the muscle skeletal system have more incidence with the advance of age, beside others that are almost exclusive of these population and are chronic illness, not deadly with cumulative frequence ones predisposing the others. Is in this context that is situated the responsability of the attention and care of the older with sarcopenia, having to the nursing like member of a interdisciplinar group, make efforts to act in the prevention, guidance, supervision and management of the assistance.

The role of the specialist nurse in pelvic floor dysfunction.

Pelvic floor dysfunction can have a devastating effect on people's lives. The specialist nurse can play a vital role within the multidisciplinary team to help improve the quality of life for these patients by offering conservative management and support through surgical treatment options.

Pelvic muscle relaxation. Assessment and management.

Strong pelvic musculature is important to the health of women because of the role it plays in maintaining urinary continence and in providing support to the pelvic organs. Therefore, assessment for pelvic muscle relaxation and strategies for preventive and therapeutic management are necessary elements of care. This paper discusses several assessment techniques that were tested in research settings but that are readily transferable to clinical care. Research-based recommendations for nurse-midwifery management, with emphasis on effective teaching of pelvic muscle exercise, are made. Pelvic muscle exercise is a noninvasive technique that should be used as the initial treatment of urinary incontinence, before a surgical alternative is tried. Moreover, women with weaker pelvic musculature, who are identified early, can begin a program of preventive exercise that may help to avoid incontinence in later life.