Health Professionals' Motivational Strategies to Enhance Adherence in the Rehabilitation of People with Lower Limb Fractures: Scoping Review.

Patients with lower limb fractures require rehabilitation but often struggle with adherence to interventions. Adding motivational strategies to rehabilitation programs can increase patient adherence and enhance outcomes. This review aims to identify the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We used Arksey and O'Malley's methodological framework to structure and conduct this scoping review. The literature search was performed using the Scopus, CINAHL, MEDLINE, Nursing & Allied Health, and Cochrane Central Register of Controlled Trials databases. The final search was conducted in February 2023. A total of 1339 articles were identified. After selecting and analyzing the articles, twelve studies were included in this review. Health professionals use several strategies to motivate patients with lower limb fractures to adhere to rehabilitation programs. These strategies include building a therapeutic alliance, increasing patients' health literacy, setting achievable goals, personalizing the rehabilitation program, managing unpleasant sensations of exercise, using persuasion, providing positive reinforcement, avoiding negative emotional stimulation, and helping to seek support. The motivational strategies identified may help professionals to increase patient adherence to rehabilitation for lower limb fractures. This knowledge will allow these professionals to help patients overcome barriers to rehabilitation, enhance their motivation, and ultimately improve their recovery outcomes.

Nurses' Motivations, Barriers, and Facilitators to Engage in a Peer Review Process: A Qualitative Study Protocol.

Peer review supports the integrity and quality of scientific publishing. However, although it is a fundamental part of the publishing process, peer review can also be challenging for reviewers, editors, and other stakeholders. The present study aims to explore the nurses' motivations, barriers, and facilitators in engaging in a peer review process. This qualitative, descriptive exploratory study will be developed in partnerships with three research centers. Researchers followed the consolidated criteria for reporting qualitative research (COREQ) checklist to ensure the quality of this study protocol. According to the selection criteria, the purposive sampling will be used to recruit nurse researchers that act as peer reviewers for several scientific journals in various fields of knowledge. Interviews will be conducted until data have been sufficiently consistent with meeting the initial objectives. Researchers will develop a guide comprising a set of open-ended questions to collect participants' characteristics, descriptive review behavior, and perceptions regarding their motivations, barriers, and facilitators. Researchers will analyze data using an inductive process of content analysis with the help of the QDA Miner Lite database. Findings from this study will generate knowledge that may help stakeholders identify facilitating factors and barriers and guide the development of strategies to remove or minimize these barriers.

Rehabilitation Workforce Challenges to Implement Person-Centered Care.

There is an increasing emphasis on developing person-centered care in rehabilitation settings. However, this care practice has not been fully implemented due to several factors. This study explores rehabilitation workforce perspectives on the barriers and facilitators to implementing person-centered care (PCC). This was a quantitative descriptive study, which was developed based on interviews with 12 healthcare professionals from a private institution in the region of Lisbon and Tagus Valley in Portugal. The recruitment was made in October 2020. Braun, Clarke, Hayfield, and Terry's content analysis was applied to the transcripts, and these were transcribed verbatim. The consolidated criteria for reporting qualitative research (COREQ) checklist were applied to this study. Participants described barriers such as an unsupportive organization and leadership, staff constraints, heavy workload, and resistance to change. Unique to this study, a patient's clinical characteristics were identified as barriers to person-centered care. As facilitators, they described leadership, staff satisfaction, a positive physical environment, training and education, and shared decision-making. It is essential to understand the perceptions of the rehabilitation workforce, as they play an integral role in providing PCC. This study serves as a guide to facilitate person-centered care, as it provides an understanding of key barriers and facilitators for its implementation in rehabilitation settings.

Locally Acquired Chronic Hepatitis E Followed by Epstein-Barr Virus Reactivation and Burkitt Lymphoma as a Suspected Extrahepatic Manifestation in a Liver Transplant Recipient.

BACKGROUND Hepatitis E virus (HEV) is a common cause of acute hepatitis in developing regions. In high-income countries, hepatitis E is an emergent zoonotic disease of increasing concern. Clinically, the infection is usually acute and self-limited in immunocompetent individuals, although rare chronic cases in immunocompromised patients have been reported. Both acute and chronic infections have been recently associated with several extrahepatic manifestations, including neurological and hematological disorders. CASE REPORT A case of autochthonous chronic HEV infection in a liver-transplanted man from a non-endemic country is presented. Phylogenetic analysis revealed a swine origin of the HEV human infection. Chronic hepatitis E was treated with a 9-week course of ribavirin, after which viral clearance was achieved. Subsequently, the patient developed a post-transplant lymphoproliferative disorder (PTLD) in the form of Burkitt lymphoma. At the time of lymphoma diagnosis, the patient had shown a strong reactivation of Epstein-Barr virus (EBV) infection. After additional antiviral ganciclovir therapy and chemotherapy, the patient had a complete recovery with no sequelae. CONCLUSIONS The differential diagnosis of persistently elevated transaminases in transplanted and/or immunocompromised patients should include testing for HEV by appropriate nucleic acid techniques (NATs). Cases of HEV infection with an atypical clinical outcome, such as the one presented herein, highlights the need for increased awareness of chronic hepatitis E and its association with a wide range of extrahepatic manifestations.

Bacteriemias por bacilos Gram negativos multirresistentes en neutropénicos febriles con enfermedades hematológicas / Bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematological diseases

Las infecciones por bacilos Gram negativos multiresistentes (BGN-MR) son frecuentes en nuestro hospital. Presentan limitadas opciones terapéuticas e importante impacto en la morbimortalidad y costos. Objetivo: analizar los factoes de riesgo y evolución de las bacteriemias por BGN-MR en pacientes neutropénicos febriles con patologías hematológicas. Materiales y métodos: estudio prospectivo, descriptivo y observacional de los factores de riesgo para BGN-MR en la población descripta. Se realizó análisis univariado y multivariado de variables clínicas, epidemiológicas, microbiológicas y evolutivas. Resultados: El 27 % de los episodios de neutropenia y fiebre cursaron con bacteriemias por BGN, 42 % de ellos fueron producidos por BGN-MR. En el análisis univariado, dichas bacteriemias se asociaron al uso previo de antibióticos; a las bacteriemias de brecha y neutropenias mayores a 7 días. En el análisis multivariado la bacteriemia de brecha mantuvo su significancia estadística (P<0,001; OR: 5,17; IC 95 % 2,1-12,7). Acinetobacter spp fue el BGN-MR más frecuentemente aislado incluso en los pacientes fallecidos. No se detectó el foco en el 45,9 % de los episodios. Los tratamientos inadecuados fueron significativamente más frecuentes en los pacientes con BGN-MR y la mortalidad tanto global como atribuible también se asoció significativamente al tratamiento inadecuado de las bacteriemias por BGN-MR (P<0,04;RR: 2,46;IC 95 % 1,03-5,9 y P< 0,014; RR: 3,02; IC 95 % 1,22-0,45 respectivamente). Conclusiones: Las bacteriemias por BGN-MR son frecuentes en la población estudiada en especial los que han recibido ATB previo y en las que surgen intratratamiento ATB. Recibieron con mayor frecuencia tratamiento empírico inadecuado, lo que se asoció a mayor mortalidad...

Bacterial infections by multiresistant Gram-negative bacilli (BGN-MR) are an increasing problem in our hospital with a major impact on morbidity, mortality and costs. Objective: to analize risk factors and outcome in bacteremia due to multiresistant Gram-negative bacilli in febrile neutropenic patients with hematologic diseases. Material and Methods: We conducted a prospective, descriptive and observational study to describe the risk factors and outcome of BGN-MR bacteremia in these patients. Results: Twenty seven percent of neutropenia and fever episodes had Gram-negative bacilli bacteremia and 42 % of them were caused by BGN-MR. Previous use of antibioteics, breakthrough bacteremia and prolonged neutropenia (<7 days) were significant in univariate analysis. In multivariate analysis only breakthrough bacteremia was significant (P< 0.001; OR 5,17;IC 95 % 2.1-12.7). Acinetobactersppp was the most common BGN-MR isolated in blood-stream infections and in patients who died. The source of infections was unknown in 45,9 % of the episodes. Inadequate empirical therapy was most common in BGN-MR bacteremia and it was associated with increased overall and attributable mortality (P<0.04; RR: 2.46; IC 95 % 1.03-5.9 y P<0.014; RR: 3.02; IC 95 % 1.22-7.45). Conclusions: BGN-MR was frequent in neutropenic patients with hematological diseases specially in those exposed to antibiotics and in breakthroug bacteremia. Inappropiate antimicrobial therapy was common and is associated with adverse outcome...

Peritonitis bacteriana espontánea asociada a bacteriemia por Vibrio cholerae no O1, no O139 / Spontaneous bacterial peritonitis associated with Vibrio cholerae non-O1, non-139 bacteremia

Vibrio cholerae is a Gram-negative bacilli with curved, comma shape that belongs to the family Vibrionaceae. The antigenic structure consists of a flagellar H antigen and a somatic O antigen (used to classify V cholerae in various serogroups). Serogroups 01 and 0139 have caused epidemics of cholera. Vibrio cholerae non-01 non-139 has been isolated from patients with bacteremia, acute secretory diarrhea, dysentery, abdominal pain, nausea, vomiting, fever and cellulitis. Invasive forms such as meningitis, spontaneous bacterial peritonitis (SBP) and encephalitis are uncommon. Immunosuppression and cirrhosis are risk factors for developing invasive disease. This case report describes a cirrhotic patient from Salta, Argentina, consulting for abdominal pain and fever. He was diagnosed with SBP and Vibrio cholerae non-01 non-139 bacteremia. He received antibiotic treatment with third generation cephalosporins for fourteen days with favorable clinical outcome.

Vibrio cholerae es un bacilo gramnegativo, curvo y móvil, perteneciente a la familia Vibrionaceae, que presenta antígenos flagelares H y somático O; este último permite clasificarlo en numerosos serogrupos. Los serogrupos O1 y O139 han causado epidemias de cólera. Vibrio cholerae serogrupo no O1, no O139 es no aglutinable con el antisuero específico y se manifiesta clínicamente como bacteriemias, diarrea acuosa, disentería, dolor abdominal, náuseas, vómitos, fiebre y celulitis. Raramente se describen formas invasoras tales como meningitis, peritonitis bacteriana espontánea (PBE) y cerebritis, entre otras. Dentro de los factores de riesgo para desarrollar enfermedad invasora se encuentran la inmunodepresión y la cirrosis hepática. Comunicamos el caso de un paciente procedente de la provincia de Salta, Argentina, con antecedentes de cirrosis hepática, que consulta por dolor abdominal y fiebre, en el que se diagnóstica PBE asociada a bacteriemia por Vibrio cholerae no 01, no 0139. Recibió tratamiento con cefalosporinas de tercera generación iv, por catorce días con una evolución clínica favorable.

[Spontaneous bacterial peritonitis associated with Vibrio cholerae non-O1, non-O139 bacteremia]. / Peritonitis bacteriana espontánea asociada a bacteriemia por Vibrio cholerae no O1, no O139.

Vibrio cholerae is a Gram-negative bacilli with curved, comma shape that belongs to the family Vibrionaceae. The antigenic structure consists of a flagellar H antigen and a somatic O antigen (used to classify V cholerae in various serogroups). Serogroups 01 and 0139 have caused epidemics of cholera. Vibrio cholerae non-01 non-139 has been isolated from patients with bacteremia, acute secretory diarrhea, dysentery, abdominal pain, nausea, vomiting, fever and cellulitis. Invasive forms such as meningitis, spontaneous bacterial peritonitis (SBP) and encephalitis are uncommon. Immunosuppression and cirrhosis are risk factors for developing invasive disease. This case report describes a cirrhotic patient from Salta, Argentina, consulting for abdominal pain and fever. He was diagnosed with SBP and Vibrio cholerae non-01 non-139 bacteremia. He received antibiotic treatment with third generation cephalosporins for fourteen days with favorable clinical outcome.