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1.
Transplant Cell Ther ; 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34537421

RESUMO

Increasingly, patients age ≥65 years are undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT). Although age alone is a well-documented predictor of overall survival (OS) and nonrelapse mortality (NRM), growing evidence suggests that poor functional status and frailty associated with aging may have roles as well. Our goal in the present study was to identify and improve these and other aging-related maladies by developing a multimodal supportive care program for older allo-SCT recipients. We designed and implemented a multimodal supportive care program, Enhanced Recovery in Stem Cell Transplant (ER-SCT), for patients age ≥65 years undergoing allo-SCT. The ER-SCT program consists of evaluation and critical interventions by key health care providers from multiple disciplines starting before hospital admission for transplantation and extending through 100 days post-allo-SCT. We determined the feasibility of implementing this program in a large stem cell transplantation center. After 1 year of ongoing process improvements, multiple evaluations, and enrollment, we found that a dedicated weekly clinic was necessary to coordinate care and evaluate patients early. We successfully enrolled 57 of 64 eligible patients (89%) in the first year. Our data show that a multimodal supportive care program to enhance recovery for older patients undergoing allo-SCT is feasible. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

2.
OTJR (Thorofare N J) ; 39(4): 189-196, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31046601

RESUMO

Participation refers to a state of health in which a person is able to fully engage in roles and life situations. Adults living with and beyond cancer often report persistent participation restrictions that affect their productivity and quality of life. The American Occupational Therapy Foundation convened a group of scientists from seven different disciplines in a Planning Grant Collective (PGC) to stimulate research to identify scalable ways to preserve and optimize participation among cancer survivors. Participants identified challenges, prioritized solutions, and generated novel research questions that move beyond symptom and impairment mitigation as outcomes to identify interventions that improve participation in roles and life situations. This article summarizes the PGC discussion and recommendations regarding three challenges: (a) the dynamic and multi-faceted nature of participation, (b) a need to integrate the concept of participation within the culture of oncology, and (c) identification of priority areas in which new lines of research regarding participation would be most impactful.


Assuntos
Sobreviventes de Câncer , Terapia Ocupacional , Atividades Cotidianas , Humanos , Qualidade de Vida , Projetos de Pesquisa
3.
Arch Rehabil Res Clin Transl ; 1(1-2): 100004, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33543044

RESUMO

Objective: To describe the clinical and personal factors associated with work status, distress regarding work status, and the desire to resume employment and receive help to address work challenges reported by women living with advanced breast cancer. Design: Descriptive statistics and univariate and multivariate logistic regression were used to explore factors related to employment challenges in this secondary analysis of an existing dataset. Setting: Participants were recruited from an outpatient oncology clinic specializing in breast cancer at a free-standing comprehensive cancer center. Participants: English-speaking women older than 18 years living with metastatic breast cancer with intact mental status and Karnofsky Performance Scale scores between 40 and 90 (N=163). Intervention: Not applicable. Main Outcome Measures: Dependent variables included (1) continued employment if working at the time of cancer diagnosis; (2) interest in resuming employment if working at the time of cancer diagnosis and now no longer working; (3) distress regarding vocational limitations; and (4) interest in receiving help to resume work. Results: Seventy percent of the sample was working before their cancer diagnosis (n=114), yet only 21% (n=35) was working when surveyed. Lower functional status and higher symptom burden were strongly and consistently associated with lack of work retention, distress related to vocational role limitations, and desire for help in addressing limitations (all P values<.01). Conclusions: With more people living longer with metastatic cancer, there is a need to assess and support survivors' desire and capacity to maintain employment. Participants' reduced employment was strongly associated with potentially actionable clinical targets (ie, higher symptom burden and lower functional status) that fall within cancer rehabilitation's mission.

4.
Am J Occup Ther ; 71(5): 7105395010p1-7105395010p5, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28809664

RESUMO

This Evidence Connection describes a case report of a man with non-Hodgkin's lymphoma who underwent an allogenic stem cell transplant. The occupational therapy assessment and treatment processes for an outpatient rehabilitation setting are described. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Project.


Assuntos
Fadiga/reabilitação , Linfoma não Hodgkin/reabilitação , Terapia Ocupacional/métodos , Atividades Cotidianas , Adulto , Assistência Ambulatorial , Prática Clínica Baseada em Evidências , Humanos , Linfoma não Hodgkin/terapia , Masculino , Determinação de Necessidades de Cuidados de Saúde , Modalidades de Fisioterapia , Retorno ao Trabalho , Transplante de Células-Tronco , Transplante Homólogo
5.
Arch Phys Med Rehabil ; 97(11): 2006-2015, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27237580

RESUMO

The health care delivery system in the United States is challenged to meet the needs of a growing population of cancer survivors. A pressing need is to optimize overall function and reduce disability in these individuals. Functional impairments and disability affect most patients during and after disease treatment. Rehabilitation health care providers can diagnose and treat patients' physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population. However, few care delivery models integrate comprehensive cancer rehabilitation services into the oncology care continuum. The Rehabilitation Medicine Department of the Clinical Center at the National Institutes of Health with support from the National Cancer Institute and the National Center for Medical Rehabilitation Research convened a subject matter expert group to review current literature and practice patterns, identify opportunities and gaps regarding cancer rehabilitation and its support of oncology care, and make recommendations for future efforts that promote quality cancer rehabilitation care. The recommendations suggest stronger efforts toward integrating cancer rehabilitation care models into oncology care from the point of diagnosis, incorporating evidence-based rehabilitation clinical assessment tools, and including rehabilitation professionals in shared decision-making in order to provide comprehensive cancer care and maximize the functional capabilities of cancer survivors. These recommendations aim to enable future collaborations among a variety of stakeholders to improve the delivery of high-quality cancer care.


Assuntos
Institutos de Câncer/organização & administração , Neoplasias/reabilitação , Avaliação da Deficiência , Serviços de Assistência Domiciliar/organização & administração , Humanos , Modalidades de Fisioterapia , Sobreviventes , Estados Unidos
6.
Am J Occup Ther ; 70(1): 7001090010p1-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26709420

RESUMO

Occupational therapy practitioners play an important role in improving the health of populations through the development of occupational therapy interventions at the population level and through advocacy to address occupational participation and the multiple determinants of health. This article defines and explores population health as a concept and describes the appropriateness of occupational therapy practice in population health. Support of population health practice as evidenced in the official documents of the American Occupational Therapy Association and the relevance of population health for occupational therapy as a profession are reviewed. Recommendations and directions for the future are included related to celebration of the achievements of occupational therapy practitioners in the area of population health, changes to the Occupational Therapy Practice Framework and educational accreditation standards, and the importance of supporting, recognizing, rewarding, and valuing occupational therapy practitioners who assume roles in which direct care is not their primary function.


Assuntos
Planejamento em Saúde Comunitária/organização & administração , Terapia Ocupacional , Atenção Primária à Saúde/organização & administração , Planejamento em Saúde Comunitária/tendências , Humanos , Atenção Primária à Saúde/tendências
7.
Am J Occup Ther ; 67(4): 383-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23791312

RESUMO

Pediatric occupational therapy practitioners face a complex and ever-changing health care environment, creating many challenges and opportunities. P4 medicine is a systems approach to health care that emphasizes proactive wellness over reactive acute care disease management. The four Ps of P4 medicine stand for predictive, personalized, preventive, and participatory, concepts that align well with the practice of pediatric occupational therapy. P4 medicine offers a model for pediatric occupational therapy practitioners to demonstrate the value of occupational therapy services.


Assuntos
Crianças com Deficiência/educação , Terapia Ocupacional/organização & administração , Criança , Pré-Escolar , Crianças com Deficiência/reabilitação , Comportamentos Relacionados com a Saúde , Humanos , Serviços de Saúde Mental , Modelos Organizacionais , Terapia Ocupacional/legislação & jurisprudência , Terapia Ocupacional/normas , Patient Protection and Affordable Care Act , Medicina de Precisão , Estados Unidos
11.
Am J Occup Ther ; 63(1): 13-23, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19192724

RESUMO

Social justice and occupational justice have received increased attention in the occupational therapy literature. This evolving discourse has focused on establishing a connection between the effects of social injustice and the resulting negative influences on occupational participation. This literature has also addressed the role of occupational therapists in responding to social injustice at the societal, population, or individual levels. We examine the two most well-known theories of social justice to understand the responsibility of organizations, institutions, or governments in providing for people who have experienced difficulties in maintaining self-sufficiency. We use two case examples to illustrate how community-based organizations act as brokers of human, financial, and other resources and the challenges they face in distributing these resources in a manner consistent with social justice concepts. Finally, we suggest how an occupational therapist might assist such organizations in fairly distributing resources by applying occupational therapy paradigmatic knowledge and skills.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Moradias Assistidas , Disparidades em Assistência à Saúde , Terapia Ocupacional , Justiça Social , Atividades Cotidianas , Adulto , Afro-Americanos , Grupo com Ancestrais do Continente Europeu , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Preconceito , Autocuidado
12.
Am J Occup Ther ; 62(1): 36-45, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18254429

RESUMO

OBJECTIVE: This study assessed the effectiveness of a model program designed to increase productive participation among people living with HIV/AIDS within supportive-living facilities. METHODS: Using a nonrandomized, two-group design, 65 study participants were assigned to either the model program or standard care. Data on productive participation were collected at 3, 6, and 9 months after completion of the model or standard program. Outcomes were compared at each time point. RESULTS: Forty-six participants completed the study. Participants in the two programs did not differ significantly on baseline demographic variables. Model program participants showed significantly higher levels of productive participation at all three time points (p < .05). Odds ratios were all > 3, reflecting that participants attending the model program were at least twice as likely to be productively engaged at all three time points. CONCLUSION: Results support the effectiveness of the model program in achieving sustained productive participation in persons living with HIV/AIDS.


Assuntos
Infecções por HIV , Participação do Paciente , Moradias Assistidas , Chicago , Feminino , Humanos , Masculino , Terapia Ocupacional , Razão de Chances , Avaliação de Programas e Projetos de Saúde
13.
Scand J Occup Ther ; 14(4): 258-64, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17852960

RESUMO

This study aims to determine the utility of the narrative slope in predicting the vocational/productive outcomes of participants. For 65 participants living in supportive facilities for adults with HIV/AIDS in the United States, narrative slopes, based on the Occupational Performance History Interview II, were constructed and classified as progressive, stable, or regressive. Information regarding participants' productive activities was collected at discharge from intervention programming, and at 3-month intervals, up to 9 months. Data were analyzed to examine the relationship between narrative slope and engagement in employment and other productive activity post-intervention. Demographic variables were also analyzed. None of the demographic factors significantly correlated to outcomes. It was found that a more positive narrative slope was predictive of a higher likelihood of being employed or engaged in other productive activity.


Assuntos
Avaliação da Deficiência , Emprego , Infecções por HIV/prevenção & controle , Narração , Reabilitação Vocacional , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estados Unidos
15.
16.
Work ; 27(3): 255-66, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17006002

RESUMO

Medical advances have transformed HIV/AIDS from a short-term terminal illness to a long-term chronic condition. Consequently, the disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities and wider community participation. These changes have necessitated rehabilitation interventions for persons with HIV/AIDS to focus on issues related to enabling participation in all spheres of everyday activities. However, limited information is available on the impairments prevalent in the emergent population of people living with HIV/AIDS and on the impact of these impairments on the person's functional performance and participation in various occupations of daily living. The present study attempted to explore these issues as they are experienced by the emergent population of people living with HIV/AIDS. The purpose of the study was: (1) to explore occupational functioning across various activities, (2) to describe the various impairments prevalent in this population, and (3) to examine the impact of these impairments on the person's perceived occupational competence. Two instruments, the Sign and symptom checklist for persons with HIV disease and the Occupational Self-Assessment were administered to a sample of 35 individuals (Mean age=42.8 yrs.) living in supportive living facilities. Impairments most commonly identified by the participants included: fatigue; fear/worries; difficulty concentrating; muscle aches; and depression. The two primary areas of occupational functioning where participants reported experiencing moderate to severe difficulty included: managing finances and physically engaging in activities which were reported by 67.7% and 35.5% of the participants respectively. No statistically significant correlation was observed between various measures of impairments and the overall measure of perceived occupational competence for the sample of individuals living with HIV/AIDS included in this study.


Assuntos
Pessoas com Deficiência , Soropositividade para HIV , Autoimagem , Autoeficácia , Adulto , Emprego , Feminino , Soropositividade para HIV/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
17.
Work ; 27(3): 267-76, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17006003

RESUMO

AIMS: The aim of this study was to examine and describe the relationship between the efforts of twelve men living with AIDS to reestablish a worker role following completion of a vocational rehabilitation program and changes in their occupational identity, occupational competence and perception of occupational settings (environment). METHODS: A series of in-depth interviews were conducted, transcribed and analyzed via categorical content analysis using sections of the text as the unit of analysis. FINDINGS: Findings illustrate how constructs measured by the sub-scales of the OPHI-II may be helpful in understanding how persons frame past, present and anticipated experiences as they attempt to reestablish a life role lost after the onset of disability. The findings are supported by the quantitative item hierarchies of the occupational identity, occupational competence and occupational settings (environment) scales established in earlier quantitative research via Rasch analysis. CONCLUSION: The constructs of occupational identity, occupational competence and occupational settings (environment) are useful constructs to aid in understanding the experiences and narratives of persons attempting to reenter a major life role.


Assuntos
Emprego , Soropositividade para HIV , Reabilitação Vocacional , Autoimagem , Autoeficácia , Humanos , Entrevistas como Assunto , Masculino , Estados Unidos
18.
Work ; 27(3): 287-94, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17006005

RESUMO

The purpose of this qualitative study was to identify the perception of interdisciplinary staff members regarding the impact of a model work and independent living oriented program for residents in supportive living facilities. This study used focus groups and individual interviews to collect these perceptions. Staff members identified four areas of impact: utilization of a holistic and process-oriented approach, an ability to identify and work with the strengths of clients, emphasis on the learning of practical skills, and creating an intersection for all aspects of services. These findings point to the fact that staff members found the value that occupational therapy has to offer their overall programming by improving participation of clients with HIV in learning practical skills for use in their daily lives and in developing work related skills.


Assuntos
Atitude do Pessoal de Saúde , Soropositividade para HIV , Equipe de Assistência ao Paciente , Reabilitação Vocacional , Grupos Focais , Humanos , Entrevistas como Assunto
19.
Work ; 27(3): 295-303, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17006006

RESUMO

It has been a little over one decade since the introduction of the first protease inhibitor that ushered in new era of treatment for persons living with human immunodeficiency virus (HIV) and Acquired Immune-Deficiency Syndrome (AIDS). As of the end of 2003, an estimated 37.8 million people worldwide were infected with the HIV. It is estimated that there are 850,000-950,000 persons in the United States living with human immunodeficiency virus (HIV) and that the incident rate is new cases each year. Since AIDS affects so many people of working age in the US, issues of employment, work rehabilitation and AIDS in the workplace have all become major concerns. The paper presents a review of the literature published during a ten year period that is relevant to understanding the various needs and barriers related to work as well as services designed to address them.


Assuntos
Terapia Antirretroviral de Alta Atividade , Emprego , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV , Humanos , Reabilitação Vocacional , Estados Unidos
20.
Work ; 27(3): 313-8, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17006008

RESUMO

OBJECTIVES: This study examined the psychometric properties of the rating scale of the Worker Role Interview (WRI). The study also asked whether the scale's items formed a valid measure of the construct, psychosocial capacity for work, and whether they were targeted to and could effectively discriminate between persons at different levels of psychosocial ability for work. METHOD OF STUDY: Data were collected from 21 raters on 440 participants from the United States, Sweden and Iceland. A many-faceted Rasch model was used to analyze the data. RESULTS: Most items of the scale worked effectively to measure the underlying construct for which the WRI was designed. In addition, the items were ordered from least to more of the underlying construct as expected. The scale validly measured 90.23% of the participants, who varied by nationality, culture, age and diagnostic status. The scale's items distinguished participants into approximately three different strata and were appropriately targeted to the participants. Seventeen of the 21 raters used scale in a valid manner. CONCLUSIONS: The WRI scale and items are valid across ages, diagnoses, and culture and effectively measure a wide range of persons.


Assuntos
Emprego , Entrevistas como Assunto , Psicometria , Papel (figurativo) , Adulto , Países Desenvolvidos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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