Management of acute stroke in the elderly: follow-up of a controlled trial.

Follow-up of a controlled trial of the management of acute stroke in the elderly showed that the improvement in functional outcome at the time of discharge from hospital that had been achieved through establishing a stroke unit had disappeared by one year. Factors that might have contributed to this included overprotection by the families of patients who had been treated in the stroke unit, who were not permitted to carry out activities of daily living in which they were independent, and the early discharge from medical units of patients whose full rehabilitation potential had not been realised. Prolonging the benefits of short-term gains in functional outcome through the intervention of a stroke unit requires that all the links in the chain of stroke rehabilitation are maintained, including the proper orientation of patients'' families before discharge from hospital.     

Downregulation of microRNA‐15a‐3p is correlated with clinical outcome and negatively regulates cancer proliferation and migration in human osteosarcoma

In this study, we investigated the expression, correlation to clinical outcomes and biological functions of microRNA‐15a‐3p (miR‐15a‐3p) in human osteosarcoma. MiR‐15a‐3p expressions in osteosarcoma cell lines and clinical tissues of osteosarcoma patients were measured by qPCR. Relevance of endogenous miR‐15a‐3p to osteosarcoma patients' clinicopathological factors or overall survival was statistically analyzed. In addition, the independence of miR‐15a‐3p predicting cancer patients' overall survival was analyzed by Cox regression method. Furthermore, in osteosarcoma cell lines, Saos‐2 and HOS cells, miR‐15a‐3p was overexpressed through stable lentiviral transduction. The functional regulations of miR‐15a‐3p overexpression on cancer ell proliferation and migration were then analyzed. MiR‐15a‐3p was significantly downregulated in osteosarcoma cell lines and human osteosarcoma tumors. Downregulation of endogenous miR‐15a‐3p in osteosarcoma tumors was significantly associated with cancer patient's poor clinical outcomes and low survival rate. Also, endogenous miR‐15a‐3p was confirmed to be an independent biomarker for predicating cancer patients' survival. In Saos‐2 and HOS cells, lentivirus‐induced miR‐15a‐3p overexpression had significantly tumor suppressing functions, by inhibiting both proliferation and migration. Significant downregulation of miR‐15a‐3p in osteosarcoma may be an independent biomarker to predicting cancer patients' poor prognosis. Overexpression miR‐15a‐3p may be an efficient functional meaning to suppress osteosarcoma development.     

Bilateral lower limb amputee rehabilitation. A retrospective review.

We retrospectively reviewed 61 cases of bilateral lower limb amputations in patients admitted to a regional amputee rehabilitation program. Of the 61 cases, 41 were analyzed as to functional outcome on discharge, at 1 month, and at 3 months; 20 were not included owing to transfers to acute care or loss to follow-up. There were 41 men and 20 women, the average age was 61.5 years, and 47 patients (77%) were discharged to home. There were 25 bilateral below-knee, 14 above-knee and below-knee, 12 bilateral above-knee, 5 below-knee and partial-foot, 3 above-knee and partial-foot, and 2 bilateral partial-foot amputations. The average length of stay for all levels was 24.2 days. Most of the patients at the time of discharge achieved a level of limited household walking with the exception of those with bilateral above-knee amputations. A significant improvement in function was noted for all patients at 3-month follow-up, with most patients achieving household ambulation level, but 10 remained independent at wheelchair level for mobility.     

早期渐进性康复训练对机械通气重症患者神经肌肉功能恢复的影响

目的:探讨早期渐进性康复训练对行机械通气重症患者神经肌肉功能的影响。方法:选择我院自2015年4月~2016年4月收治的80例机械通气重症患者。通过随机数字表法将患者分为观察组及对照组各40例,患者进入ICU后,给予所有患者常规的机械通气治疗方案及干预。在此基础上给予观察组患者早期渐进性康复训练,分别于气管插管拔管时、转出ICU时以及出院时采用功能独立性评分表(FIM)对两组患者功能独立性水平进行评价,统计比较两组患者机械通气时间、ICU治疗时间、住院总时间及并发症的发生情况。结果:气管插管拔管时观察组自理能力、括约肌控制、转移功能及总分水平均高于对照组,差异均有统计学意义(均P0.05)。转出ICU时和出院时观察组自理能力、括约肌控制、转移、行进、交流、社会认知及总分水平均高于对照组,差异均有统计学意义(均P0.05)。观察组机械通气时间、ICU治疗时间及住院总时间及并发症发生率低于对照组,差异有统计学意义(P0.05)。结论:早期渐进性康复训练可有效者提高ICU患者自理能力,加速患者意识的恢复,使患者更早的脱机,减少住院时间,降低并发症情况的发生。     

Are geriatric units needed for elderly patients with hip fractures?

To assess the need for a multidisciplinary geriatric unit in the treatment of elderly patients with hip fractures, we reviewed the charts of all patients aged 60 years or older who were treated for hip fractures in five hospitals in Hamilton, Ont., between August 1982 and September 1983. We hypothesized that discharge to a different location from that before admission would indicate reduced functional status and classified the reasons for a change in residence as poor patient motivation, need for rehabilitation, compromised ambulation, postoperative complications and inevitable deterioration. We believed that geriatric care would be most beneficial to those in the first three groups. Of the 327 patients with hip fractures 40 (12%) died before discharge. Of the 287 surviving patients 149 (52%) had been discharged by 4 weeks, and only 29 (10%) remained in hospital by 12 weeks. Of the 287, 44 (15%) were discharged to a different location from that before admission: in 75% the cause appeared to be inevitable deterioration (57%) or postoperative complications (18%). The remaining 25% needed rehabilitation and were all sent to appropriate facilities. None of the patients with ambulation problems or poor motivation required an increased level of care. We could not show a need for geriatric care in our population; possible explanations are discussed.     

Correlation between rest-activity rhythm and survival in cancer patients experiencing pain

The purpose of this study was to investigate the influence of rest-activity rhythm on the survival of cancer patients. This study collected data related to cancer patients experiencing pain who had been hospitalized for treatment between August 2006 and October 2007. Data included the Karnofsky Performance Status Index as a representation of functional condition as well as the Brief Pain Inventory and the Pittsburgh Sleep Quality Index. Actigraphic methods were used to record the dichotomy index (I?<?O) of patients' rest-activity rhythms over periods of three consecutive days. Patients were closely followed until 31 July 2013. Results were analyzed using Kaplan–Meier survival analysis, log-rank testing and Cox proportional hazards regression analysis to evaluate whether alterations in the rest-activity rhythm affected the survival rate of the patients. Of the 68 hospitalized cancer patients experiencing pain at the time of admission, 51 subsequently died within the study period. A significant difference was observed in the survival curves between the regular I?<?O group and the disrupted I?<?O group (log rank?=?7.942, p?=?0.005). A multivariable proportional hazard model was used for analysis of overall survival, revealing that the risk of death within the study period among patients with disrupted I?<?O was 4.59 times higher than that of patients with regular I?<?O (95% CI: 1.92–10.96, p?=?0.001). Among patients with poor performance status, the risk of death among patients with disrupted I?<?O was 8.68 times higher than that of patients with regular I?<?O (95% CI: 2.50–30.09, p?=?0.001). Disruptions in rest-activity rhythm were negatively correlated with the survival of hospitalized cancer patients experiencing pain. Effects were particularly pronounced in cancer patients with poor performance status.     

流程管理配合肠内营养对大肠癌手术患者的临床效果

目的:探讨流程管理的护理模式对大肠癌患者术后早期空肠营养的作用,为临床护理提供可借鉴的方法。方法:选择2010年3月-2013年12月在我院接受手术治疗的大肠癌患者93例,随机分为研究组和对照组。其中,研究组51例患者采取流程管理的模式进行空肠营养护理,而对照组42例患者采用基础护理模式。观察并比较两组患者的临床效果及对护理服务的满意度。结果:实施护理干预配合肠内营养支持治疗后,两组患者的营养状况与之前比较均获得明显改善(P0.05);研究组患者的平均住院时间、肠道功能恢复时间、血淀粉酶及尿淀粉酶等各项指标恢复情况均显著优于对照组,差异具有统计学意义(P0.05)。对照组患者对护理服务的满意度为85.71%,研究组患者对护理服务的满意度为100.00%,两组比较差异显著具有统计学意义(P0.05)。结论:流程管理护理配合早期肠内营养能够改善患者术后的营养状况,提高机体免疫功能,而且有利于提高患者对护理服务的满意度,值得推广。     

Evaluation of a stroke family care worker: results of a randomised controlled trial.

OBJECTIVE: To examine the effect of contact with a stroke family care worker on the physical, social, and psychological status of stroke patients and their carers. DESIGN: Randomised controlled trial with broad entry criteria and blinded outcome assessment six months after randomisation. SETTING: A well organised stroke service in an Edinburgh teaching hospital. SUBJECTS: 417 patients with an acute stroke in the previous 30 days randomly allocated to be contacted by a stroke family care worker (210) or to receive standard care (207). The patients represented 67% of all stroke patients assessed at the hospital during the study period. MAIN OUTCOME MEASURES: Patient completed Barthel index, Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, mental adjustment to stroke scale, and patient satisfaction questionnaire; carer completed Frenchay activities index, general health questionnaire, hospital anxiety and depression scale, social adjustment scale, caregiving bassles scale, and carer satisfaction questionnaire. RESULTS: The groups were balanced for all important baseline variables. There were no significant differences in physical outcomes in patients or carers, though patients in the treatment group were possibly more helpless less well adjusted socially, and more depressed, whereas carers in the treatment group were possibly less hassled and anxious. However, both patients and carers in the group contacted by the stroke family care worker expressed significantly greater satisfaction with certain aspects of their care, in particular those related to communication and support. CONCLUSIONS: The introduction of a stroke family care worker improved patients'' and their carers'' satisfaction with services and may have had some effect on psychological and social outcomes but did not improve measures of patients'' physical wellbeing.     

An investigation into the management of bilateral leg amputees.

Patients with bilateral high level amputations of the legs are rarely functionally independent after their discharge from hospital. Eighty bilateral amputees were visited by a research physiotherapist, and information was obtained on their family circumstances, accommodation, mobility, and prostheses. A second questionnaire was completed by hospital staff on medical condition, assessments, rehabilitation, and total overall management. The results showed that mobility was severely restricted; out of the 80 patients visited, only 65 could manoeuvre wheelchairs and 23 use prostheses. Accommodation presented difficulties: 34 homes had steps inside and 40 had steps outside. Of the 80 patients seen, 60 could not cope in the bath while 33 were unable to use the lavatory. Assessments and rehabilitation were lacking. There appeared to be little overall management, and hospital staff made only 36 visits to the patient''s accommodation before discharge.     

Respiratory poliomyelitis: a follow-up study.

Data from the medical records of 113 patients living in Manitoba who had contracted respiratory poliomyelitis between 1952 and 1959 were compared with information obtained from interviews with these patients in 1980. The study was designed to determine whether the patients'' respiratory function, mobility, ability to perform daily tasks, and employment, residential and marital status had changed between 1 year after the onset of polio and 1980. The patients'' dependence on mechanical aids and other people was also studied. More than half (56%) of the patients perceived their respiratory impairment to be the same as it was 1 year after the onset of polio, 27% perceived the impairment to be increased, and 17% perceived it to be decreased. There was an association between level of respiratory function, mobility and ability to perform daily tasks. The 69 patients who lived at home had better respiratory function, mobility and ability to perform daily tasks than the 24 patients who were assisted by a home care program and the 20 who lived in hospital. The latter group had the lowest levels of respiratory and functional ability.     

A rehabilitation ward in a district general hospital: first three years' experience.

The experience of the first three years'' work on a ward for the rehabilitation of patients was reviewed. Adults with physical disabilities or mixed physical and psychological disabilities, including unstable or deteriorating conditions, were accepted for intensive rehabilitation. Most patients had neurological disorders. The ward policy was that each patient had considerable time with the therapist, maximum personal independence was encouraged, and multidisciplinary staff meetings were held to agree the goals of treatment. Much effort was spent helping patients and relatives to adapt to conditions of progressive disability, but the response to questionnaires suggested that these patients as well as those who did improve received some benefit from being on the ward. Overall the benefits of the intensive rehabilitation that was offered on this ward outweighed those from short stays on medical wards.     

Multicentre study of cancer pain and its treatment in France.

OBJECTIVE--To describe the treatment of cancer pain in France and to evaluate the predictive factors for inadequate management. DESIGN--Multicentre, representative cross sectional survey. SETTING--20 treatment centres, including cancer centres, university hospitals, state hospitals, private clinics, and one homecare setting (in which patients are supported at home). SUBJECTS--605 patients with cancer. MAIN MEASURES--Patients rated prevalence and severity of pain and functional impairment related to pain. Doctors reported patients'' cancer characteristic, performance status, pain severity, and analgesic drugs ordered. RESULTS--57% (340/601) of patients with cancer reported pain due to their disease, and, of those with pain, 69% (224/325) rated their worst pain at a level that impaired their ability to function. 30% (84/279) were reported as receiving no drugs for their pain. Of the 270 patients in pain for whom information on treatment was available 51% (137/270) were not receiving adequate pain relief, according to an index based on the World Health Organisation''s guidelines. French doctors were found to underestimate the severity of their patients'' pain. Younger patients, patients without metastatic disease, patients with a better performance status, and patients who rated their pain as more severe than their doctors did were at greater risk for undertreatment of their pain. CONCLUSIONS--In the light of the high prevalence and the severity of pain among patients with cancer, the assessment and treatment of cancer pain in France remain inadequate, emphasising the need for changes in patient care.     

Factors necessary for independent walking in patients with thalamic hemorrhage

Background

Thalamic hemorrhages cause motor paralysis, sensory impairment, and cognitive dysfunctions, all of which may significantly affect walking independence. We examined the factors related to independent walking in patients with thalamic hemorrhage who were admitted to a rehabilitation hospital.

Methods

We evaluated 128 patients with thalamic hemorrhage (75 men and 53 women; age range, 40–93 years) who were admitted to our rehabilitation hospital. The mean duration from symptom onset to rehabilitation hospital admission was 27.2 ± 10.3 days, and the mean rehabilitation hospital stay was 71.0 ± 31.4 days. Patients’ neurological and cognitive functions were examined with the National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination (MMSE), respectively. The relationship between patients’ scores on these scales and their walking ability at discharge from the rehabilitation hospital was analyzed. Additionally, a decision-tree analysis was used to create a model for predicting independent walking upon referral to the rehabilitation hospital.

Results

Among the patients, 65 could walk independently and 63 could not. The two patient groups were significantly different in terms of age, duration from symptom onset to rehabilitation hospital admission, hematoma type, hematoma volume, neurological symptoms, and cognitive function. The decision-tree analysis revealed that the patient’s age, NIHSS score, MMSE score, hematoma volume, and presence of ventricular bleeding were factors that could predict independent walking.

Conclusions

In patients with thalamic hemorrhage, the neurological symptoms, cognitive function, and neuroimaging factors at onset are useful for predicting independent walking.

     

Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study

Objective: This multicenter study examined whether inpatient rehabilitation outcomes following total knee arthroplasty (TKA) were influenced by BMI. Methods and Procedures: This was a retrospective, comparative study conducted using a computerized medical database and medical records derived from TKA patients, at 15 independent rehabilitation hospitals (N = 5,428). Patients were separated into four groups based on BMI: non‐obese (BMI < 25 kg/m²), overweight (25–29.9 kg/m²), moderately obese (30–40 kg/m²), severely obese (BMI ≥ 40 kg/m²). All patients completed an interdisciplinary inpatient rehabilitation program post‐TKA. Total and individual functional independence measure (FIM) scores, length of stay (LOS), FIM efficiency scores, itemized hospital charges, and discharge disposition location, were collected. Results: The percentage of total FIM change was 7.5% greater by the time of discharge in the non‐obese than in the very severely obese (P < 0.05). FIM efficiency was lowest in the severely obese as compared to the remaining groups (3.7 points (pts)/day vs. 4.0–4.3 pts/day; P = 0.044). The change in the motor FIM score from admission to discharge was 6.7–15.6% greater in the non‐obese than in the remaining groups (P < 0.05). The changes in cognition FIM, toilet transfer and walking without assistance scores were higher in the non‐obese as compared to the severely obese group (P < 0.05). The severely obese group had higher total, physical and occupational therapy and pharmacy charges than the remaining groups (P < 0.05). Discussion: An excessive BMI does not prevent gains during inpatient rehabilitation; however, these gains are made less efficiently and at a higher cost than those made when the BMI is low.     

The Bradford community stroke trial: results at six months.

OBJECTIVE--Comparison of day hospital attendance and home physiotherapy for stroke patients leaving hospital to determine which service produces greater functional and social improvement for the patient, reduces emotional stress for the care giver, and lessens the need for community support. DESIGN--Stratified, randomised trial of stroke patients attending day hospital two days a week or receiving home treatment from a community physiotherapist. The six month assessment results are reported in this paper. SUBJECTS--Patients over 60 years old resident within the Bradford metropolitan district discharged home after a new stroke with residual disability. SETTING--Four day hospitals in two health authorities and domiciliary work undertaken by experienced community physiotherapists. MAIN OUTCOME MEASURES--Barthel index, functional ambulatory categories, Motor Club assessment, Frenchay activities index, and Nottingham health profile were used. Carers'' stress was indicated by the general health questionnaire. Treatment given and community care provided were recorded. RESULTS--Of 124 patients recruited, 108 were available for reassessment at six months. Both treatment groups had significantly improved in functional abilities between discharge and six months. The improvements were significantly greater for patients treated at home (Mann-Whitney test; Barthel index, median difference 2 (95% confidence interval 0 to 3) p = 0.01; Motor Club assessment, median difference 2 (1 to 5), p = 0.01). The home treated patients received less treatment (median difference 16 (11 to 21) treatments, p less than 0.001). More than a third of patients in both groups showed depressed mood, and a quarter of care givers were emotionally distressed. CONCLUSIONS--Home physiotherapy seems to be slightly more effective and more resource efficient than day hospital attendance and should be the preferred rehabilitation method for aftercare of stroke patients. New strategies are needed to address psychosocial function for both patients and care givers.     

Effects of case management after severe head injury.

OBJECTIVES--To examine the effects of early case management for patients with severe head injury on outcome, family function, and provision of rehabilitation services. DESIGN--Prospective controlled unmatched non-randomised study for up to two years after injury. SETTING--Four district general hospitals and two university teaching hospitals, each with neurosurgical units, in east central, north, and north east London and its environs. SUBJECTS--126 patients aged 16-60 recruited acutely and sequentially after severe head injury. All received standard rehabilitation services in each of the six hospitals and districts: case management was also provided for the 56 patients admitted to three of the hospitals. MAIN OUTCOME MEASURES--Standard measures of patients'' physical and cognitive impairment; disability and handicap; and affective, behavioural, and social functioning and of relatives'' affective and social functioning. Relatives'' perception of burden; changes in patients'' and relatives'' housing, financial, vocational, recreational, and medical needs; and ongoing requirements for care and support; and the amount and type of paramedical input provided were assessed with structured questionnaires. RESULTS--For a given severity of injury, case management increased the chance and range of contact with inpatient and outpatient rehabilitation services. However, duration of contact was not increased by case management, and there was no demonstrable improvement in outcome in the case managed group. Any trends were in favour of the control group and could be accounted for by group differences in initial severity of injury. CONCLUSIONS--Widespread introduction of early case management of patients after severe head injury is not supported, and early case management is not a substitute for improvement in provision of skilled and specialist rehabilitation for patients.     

Pursuit and practice of complementary therapies by cancer patients receiving conventional treatment.

OBJECTIVES--To determine what proportion of oncology patients receiving conventional medical treatment also use complementary treatments; to assess which complementary treatments are the most popular and to assess patients'' motivation for using them; to evaluate associated advantages and risks. DESIGN--Postal screening questionnaire followed by semistructured interview. SETTING--Two hospitals in inner London. SUBJECTS--600 unselected oncology patients aged 18 or over who had known their diagnosis of cancer for at least three months. MAIN OUTCOME MEASURES--Prevalence and demography of use of complementary therapies; patients'' motivation and expectations of complementary therapies; areas of satisfaction and dissatisfaction associated with conventional and complementary therapies. RESULTS--415 (69%) patients returned the questionnaire. 16% had used complementary therapies. The most popular were healing, relaxation, visualisation, diets, homoeopathy, vitamins, herbalism, and the Bristol approach. Patients using complementary therapies tended to be younger, of higher social class, and female. Three quarters used two or more therapies. Therapies were mostly used for anticipated antitumour effect. Ill effects of diets and herb treatments were described. Satisfaction with both conventional and complementary therapies was high, although diets often caused difficulties. Patients using complementary therapies were less satisfied with conventional treatments, largely because of side effects and lack of hope of cure. Benefits of complementary therapies were mainly psychological. CONCLUSIONS--A sizeable percentage of patients receiving conventional treatments for cancer also use complementary therapies. Patient satisfaction with complementary therapies, other than dietary therapies, was high even without the hoped for anticancer effect. Patients reported psychological benefits such as hope and optimism.     

围手术期乳腺癌患者社会支持状态及相关因素的调查研究

目的:调查围手术期乳腺癌患者社会支持状态及其相关因素,分析影响围手术期乳腺癌患者的促进和阻碍因素,为提高围手术期乳腺癌患者社会支持状态提供理论基础。方法:自2012年1~6月对在哈尔滨医科大学附属第二医院普外八病房进行手术治疗的96例乳腺癌患者进行问卷调查,调查内容为自制调查问卷,主要包括患者的社会支持状态、焦虑及一般人口学资料。结果:围手术期乳腺癌患者社会支持得分为(69.49±7.43)分,状态焦虑得分为(41.61±12.01)分,特质焦虑得分为(41.07±11.81)分,Pearson相关分析结果显示,社会支持与特质焦虑呈负相关,一般人口学资料中社会支持的影响因素有家庭经济状况和教育程度。结论:围手术期乳腺癌患者社会支持处于高支持状态,经济状况较好、教育程度高的乳腺癌患者其社会支持水平较高,医护人员可以通过降低患者焦虑水平,提高其社会支持水平,以促进疾病的康复。