The Effect of a Comprehensive Rehabilitation Program on Respiratory Function and Functional Capacity on Patients After 1 Month to Liver Transplantation.

BACKGROUND: Physical exercise is prescribed in populations with chronic diseases, but data are scarce in the liver transplantation (LT) setting. OBJECTIVE: The aim of this study was to evaluate changes in forced expiratory volume in the first second, forced vital capacity, maximal inspiratory pressure, maximal expiratory pressure, 6-minute walking test (6MWT), 6-minute step test (6MST), Duke Activity Status Index, VO2 (mL/kg/min), and health-related quality of life (in patients submitted to a rehabilitation program, comprising physical exercise training, breathing techniques, and educational sessions after LT. METHODS: This cohort study enrolled patients to an 8-week period of thrice weekly comprehensive supervised rehabilitation program after 1 month of LT. A nonrandomized control cohort of LT patients were selected to match the rehabilitation group based on specific demographic data and severity of disease. RESULTS: The rehabilitation group, compared with the control group, showed a significant improvement in respiratory parameters (forced vital capacity [0.33L vs 0.13L,P < .01]); exercise capacity (6MWT and 6MST 71.1 vs 34.1 meters; and 30.5 vs 7.5 steps; respectively P < .01); Duke Activity Status Index scores and VO2 (21.3 vs 10.2 and 9 vs 4.3; respectively P < .01); respiratory muscle strength (maximal inspiratory pressure 21.1 vs 15.1 cmH2O and maximal expiratory pressure 21.2 vs 10.2 cmH2O; P < .01); and quality of life (SF-36 physical component summary 12.4 vs 2.9 P < .01). CONCLUSION: These data suggest that improvements in physical fitness, respiratory parameters, and quality of life are achieved with a comprehensive rehabilitation program initiated early after LT.

Com palavras não sei dizer: ressignificando o cuidado através da música em pós-operatório cardiopediátrico / With words I cannot say: giving new meaning to care through music in cardio pediatric postoperative

Objetivo: compreender as ressignificações que a música promove no cuidado às crianças em pós-operatório cardíaco. Métodos: pesquisa qualitativa com profissionais da equipe multiprofissional de saúde por meio de entrevista semiestruturada baseada no método de Análise de Conteúdo. Resultados: os profissionais perceberam a Unidade de Terapia Intensiva Pediátrica como cenário suscetível de deterioração na qualidade da assistência. Ademais, consideraram que o uso da música, como terapêutica integrativa e complementar, fomentou a produção de sentidos na atenção à saúde, mostrando-se capaz de proporcionar relaxamento, distração, bem-estar, recordações agradáveis e conforto aos profissionais e às crianças internadas. Conclusão: a música contribuiu para a ressignificação do cuidado otimizando a humanização e reestruturando os processos de promoção de saúde. A experiência proporcionou reflexões, habilidades, expressão emocional, sensações e sentimentos como relaxamento, distração e bem-estar na equipe multiprofissional. O cuidado à criança foi ampliado, aliando o arsenal tecnológico à preocupação com o conforto e estado emocional. (AU)

Comparison of the effects of pulmonary rehabilitation with chest physical therapy on the levels of fibrinogen and albumin in patients with lung cancer awaiting lung resection: a randomized clinical trial.

BACKGROUND: Systemic inflammation plays an important role in the initiation, promotion, and progression of lung carcinogenesis. In patients with non-small cell lung cancer (NSCLC), fibrinogen levels correlate with neoplasia. Here we compared the effects of pulmonary rehabilitation (PR) with chest physical therapy (CPT) on fibrinogen and albumin levels in patients with LC and previous inflammatory lung disease awaiting lung resection. METHODS: We conducted a randomized clinical trial with 24 patients who were randomly assigned to Pulmonary Rehabilitation (PR) and Chest Physical Therapy (CPT) groups. Each group underwent training 5 days weekly for 4 weeks. All patients were assessed before and after four weeks of training through clinical assessment, measurement of fibrinogen and albumin levels, spirometry, 6-minute Walk Test (6MWT), quality of life survey, and anxiety and depression scale. PR involved strength and endurance training, and CPT involved lung expansion techniques. Both groups attended educational classes. RESULTS: A mixed between-within subjects analysis of variance (ANOVA) revealed a significant interaction between time (before and after intervention) and group (PR vs. CPT) on fibrinogen levels (F(1, 22)=0.57, p<0.0001) and a significant main effect of time (F(1, 22)=0.68, p=0.004). Changes in albumin levels were not statistically significant relative to the interaction effect between time and group (F(1, 22)=0.96, p=0.37) nor the main effects of time (F(1, 22)=1.00, p=1.00) and group (F(1, 22 )=0.59, p=0.45). A mixed between-within subjects ANOVA revealed significant interaction effects between time and group for the peak work rate of the unsupported upper limb exercise (F(1, 22)=0.77, p=0.02), endurance time (F(1, 22)=0.60, p=0.001), levels of anxiety (F(1, 22)=0.60, p=0.002) and depression (F(1, 22)=0.74, p=0.02), and the SF-36 physical component summary (F(1, 22)=0.83, p=0.07). CONCLUSION: PR reduced serum fibrinogen levels, improved functional parameters, and quality of life of patients with LC and inflammatory lung disease awaiting lung resection. TRIAL REGISTRATION: Current Controlled Trials RBR-3nm5bv.