Care of the Renal Transplant Patient.

Renal transplant has become a mainstay of treatment of patients with chronic renal failure. With improving survival outcomes, primary care physicians should be informed of the nuances that come with the ongoing care of this population and feel empowered to take part in the multidisciplinary care of these patients. This article provides an overview of the renal transplant process from initial evaluation through surgery and then focuses on long-term issues that renal transplant patients face in the primary care setting.

From left ventricular assist device to transplant to home: An interdisciplinary team approach to treating medically complex cardiac patients during the bridge to transplantation: A case report.

CASE REPORT: A 56-year-old man presented with advanced heart failure requiring implantation of a left ventricular assist device and was discharged home. after implantation He returned to the hospital with right posterior putamen stroke and after a comprehensive rehabilitation programme was discharged home with the ability to be independent. The patient later underwent heart transplantation and subsequently required readmission to inpatient rehabilitation. He again completed a comprehensive rehabilitation programme and returned home with the ability to be independent with use of a single-point cane for ambulation. CONCLUSION: Patients with advanced heart failure present a challenge to the rehabilitation team, but with a multidisciplinary approach and physiatrist leadership patients can return home and achieve improved quality of life.

Rate of return to acute care hospital based on day and time of rehabilitation admission.

OBJECTIVE: To determine if a patient's return to the acute care hospital (RTACH) from an inpatient rehabilitation facility (IRF) because of medical acuity is affected by the day of the week and time of rehabilitation admission. DESIGN: Retrospective chart review. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: All adult patients admitted to the IRF from January 1, 2009, to June 30, 2011. RTACH was defined as an interruption in the patients' rehabilitation course as a result of medical and/or surgical complications requiring a higher level of care. The control group was defined as patients who completed an uninterrupted rehabilitation course. The study included 2282 patients (2026 control patients and 256 case patients). MAIN OUTCOME MEASURES: We compared patient demographics, admission impairment groups, discharge diagnosis, admission and discharge Functional Independent Measure (FIM) scores, length of stay, attached hospital versus outside hospital admissions, and RTACH rates between case patients and control patients. RESULTS: Out of 2282 patients admitted to the IRF over a 30-month period, 256 patients (10.85%) required an RTACH for a higher level of care not available in the IRF. Two statistically significant results were found for RTACH, including rehabilitation admission time and FIM scores (admission motor and cognition scores). Day of the week for inpatient rehabilitation admission was not statistically significant. CONCLUSION: This study found that the later in the day a patient was admitted to the IRF, the higher the rate of RTACH. In addition, a lower Motor FIM score was found to be correlated with a higher rate of RTACH. Admission day of the week was not found to be statistically significant with regard to the rate of RTACH. Further research is needed to determine the underlying contributing factors that would help decrease the rate of RTACH.

Current and emerging strategies for treating hepatic encephalopathy.

Hepatic encephalopathy (HE) is caused by liver impairment and has a multitude of symptoms in affected patients, including change in level of consciousness, intellectual function, and neuromuscular function. Pharmacologic therapy includes use of nonabsorbable disaccharides (lactulose and lactitol), and antibiotics such as neomycin, paromycin, metronidazole, and rifaximin. Probiotics, acarbose, and drugs such as L-carnitine and flumazenil, may also be helpful in treating HE.