Cough in tetraplegic subjects: an active process
Tetraplegic individuals are paralyzed in both the arms and legs; this condition is also known as quadriplegia. Because they have lost the function of certain nerves, these persons have little ability to use their expiratory muscles. These muscles, located in the abdomen and between the ribs, are important for exhaling air and coughing. When coughing is not efficient, the body cannot clear out lung secretions, and this can lead to serious complications such as collapsed lung and pneumonia. It has been assumed that the coughing reflex in tetraplegic persons is a passive process in which the respiratory system exhibits some elastic recoil, yet there is also evidence that tetraplegics have the use of a portion of the pectoralis major muscle. The involvement of the clavicular portion of the pectoralis major in coughing by tetraplegic patients was studied. The eight subjects were adults who had suffered a fracture-dislocation of the cervical (neck) spinal cord between the fifth and seventh vertebrae; the injuries had occurred nine months to 13 years earlier. The electrical activity in their muscles was measured as they coughed. The clavicular portion of the pectoralis major had a central role in coughing, demonstrating that coughing is an active process in these individuals. The practical implication of this finding is that tetraplegics could develop the effectiveness of their cough and prevent serious respiratory problems by muscle training. Abdominal binding may also be helpful because an unexpected outward movement of the abdomen has been observed during coughing. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
HIV Surveillance: A Dynamic, Not Static, Process to Assure Accurate Local Data
HIV patient registries should be continually updated to accurately reflect case information. One group of researchers found that four pregnant women and one non-pregnant woman who were initially identified as at high risk for HIV infection were found not to be infected. In 58% of the cases, risk factors for HIV infection were either confirmed or reclassified.
Publication Name: Sexually Transmitted Diseases
Partnership is a three-step process
Tips are provided for dentists who want to hire a partner to help provide dental services. The process can be broken into three phases to ensure a successful integration: the employment phase, the at-risk associateship, and the partnership phase. Dentists should have weekly meetings with the new partner to keep the lines of communication open.
Publication Name: Journal of the American Dental Association
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