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2.
Am J Surg ; 219(4): 587-591, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32178839

RESUMO

BACKGROUND: We sought to evaluate the role of trauma center designation in the association of race and insurance status with disposition to rehabilitation centers among elderly patients with Traumatic Brain Injury (TBI). METHODS: The National Trauma Data Bank (2014-2015) was used to identify elderly (age ≥ 65) patients with isolated moderate to severe blunt TBI who survived to discharge. Race, insurance status, and outcomes were stratified by trauma center designation and compared. RESULTS: 3,292 patients met the inclusion criteria. Black patients were 1.5 times less likely (AOR 0.64, p = 0.01) and Latino patients were 1.7 times less likely (AOR 0.58, p = 0 0.007) to be discharged to rehabilitation centers as compared with White patients. Asian patients at Level I hospitals were more likely to be discharged to rehabilitation centers if they had private vs. non-private insurance (42.9% versus 12.7%, p = 0.01). CONCLUSION: Black and Latino patients were less likely to be discharged to rehabilitation centers compared to White patients. The etiology of these disparities deserves further study.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Grupos de Populações Continentais/estatística & dados numéricos , Disparidades em Assistência à Saúde , Alta do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Cobertura do Seguro , Masculino , Sistema de Registros , Centros de Reabilitação , Estudos Retrospectivos , Instituições de Cuidados Especializados de Enfermagem , Centros de Traumatologia , Estados Unidos/epidemiologia
4.
Z Psychosom Med Psychother ; 66(1): 20-31, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32066348

RESUMO

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.


Assuntos
Competência Cultural/organização & administração , Hospitais , Transtornos Psicofisiológicos/terapia , Medicina Psicossomática/organização & administração , Psicoterapia/organização & administração , Centros de Reabilitação/organização & administração , Alemanha , Humanos , Transtornos Psicofisiológicos/etnologia , Migrantes/psicologia
5.
Med Clin North Am ; 104(2): 345-357, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035573

RESUMO

In the United States, we are blessed with many options for postacute care: inpatient rehabilitation facilities, long-term acute care hospitals, skilled nursing facilities, home health agencies, and outpatient rehabilitation. However, choosing the appropriate level of care can be a daunting task. It requires interdisciplinary input and involvement of all stakeholders. The decision should be informed by outcomes data specific to the patient's diagnosis, impairments, and psychosocial supports.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Alta do Paciente , Centros de Reabilitação/classificação , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Humanos , Comunicação Interdisciplinar , Resultado do Tratamento
6.
Med Care ; 58(5): 491-495, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31914103

RESUMO

BACKGROUND: Despite the importance of the hospital discharge destination field ("discharge code" hereafter) for research and payment reform, its accuracy is not well established. OBJECTIVES: The aim of this study was to examine the accuracy of discharge codes in Medicare claims. DATA SOURCES: 2012-2015 Medicare claims of knee and hip replacement patients. RESEARCH DESIGN: We identified patients' discharge location in claims and compared it with the discharge code. We also used a mixed-effects logistic regression to examine the association of patient and hospital characteristics with discharge code accuracy. RESULTS: Approximately 9% of discharge codes were inaccurate. Long-term care hospital discharge codes had the lowest accuracy rate (41%), followed by acute care transfers (72%), inpatient rehabilitation facility (80%), and home discharges (83%). Most misclassifications occurred within 2 broad groups of postacute care settings: home-based and institutional care. The odds of inaccurate discharge codes were higher for Medicaid-enrolled patients and safety-net and low-volume hospitals. CONCLUSIONS: Inaccurate hospital discharge coding may have introduced bias in studies relying on these codes (eg, evaluations of Medicare bundled payment models). Inaccuracy was more common among Medicaid-enrolled patients and safety-net and low-volume hospitals, suggesting more potential bias in existing study findings pertaining to these patients and hospitals.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Codificação Clínica , Medicare , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Sobreviventes de Câncer , Feminino , Serviços Hospitalares de Assistência Domiciliar , Hospitais com Baixo Volume de Atendimentos , Humanos , Masculino , Transferência de Pacientes , Centros de Reabilitação , Instituições de Cuidados Especializados de Enfermagem , Estados Unidos
7.
Codas ; 32(2): e20190046, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31851217

RESUMO

PURPOSE: Describe the implementation process of the International Classification of Functioning, Disability and Health (ICF) in a Specialized Rehabilitation Center based on the biopsychosocial approach to health. METHODS: This is a descriptive, analytical, longitudinal study. The ICF implementation process in the healthcare center encompassed four stages: a) training on the use of the ICF; b) preparation of checklists by the team; c) collection of relevant data based on the checklist from the healthcare center users; and d) construction of a database. RESULTS: A checklist was constructed for each sector involved, and the database included user information and the ICF results during evaluation and reevaluation. The findings indicate higher problem-solving capacity in all sectors throughout the study period, and that training was crucial to operationalize the ICF. Preparation of the instruments based on the reality of the healthcare center was essential to meet local demands and those of each sector. CONCLUSION: The ICF enabled greater practice of the biopsychosocial approach based on the engagement of the professionals in its operationalization, with evidence of healthcare problem-solving capacity and visibility and organization of the work process.


Assuntos
Pessoas com Deficiência , Classificação Internacional de Funcionalidade, Incapacidade e Saúde/instrumentação , Fortalecimento Institucional , Lista de Checagem , Assistência à Saúde , Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Estudos Longitudinais , Masculino , Centros de Reabilitação
8.
J Surg Res ; 245: 593-599, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499365

RESUMO

BACKGROUND: After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. MATERIALS AND METHODS: We conducted a retrospective review (January 1, 2012-June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. RESULTS: Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. CONCLUSIONS: After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported.


Assuntos
Parada Cardíaca/cirurgia , Complicações Pós-Operatórias/epidemiologia , Ressuscitação/efeitos adversos , Toracotomia/efeitos adversos , Ferimentos não Penetrantes/complicações , Ferimentos Penetrantes/complicações , Adulto , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Centros de Reabilitação/estatística & dados numéricos , Ressuscitação/métodos , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgia , Adulto Jovem
9.
Dev Neurorehabil ; 23(1): 9-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31055992

RESUMO

Aim: Aggressive incidents (AI) are a serious concern in health care and can have negative effects on the physical and emotional well-being staff. This study aimed to determine frequency, characteristics and risk factors for aggressive behavior.Methods: AI were recorded during six months by the staff in a pediatric rehabilitation clinic using the evaluation form for AI (EVA). Patients were divided into the study group (patients who were involved in AI) and controls.Results: 14/105 (13%) of patients were involved in 79 AI. 0.44 AI per day occurred. Most often AI occurred on Mondays and 98% included physical, 22% verbal aggression. Most frequent target (43%) were nurses, followed by therapists (31.6%).Significant risk factors for AI were: previous aggressive behavior (p = .038), lower cognitive and higher mobility sub-scores in the WeeFIM. Conclusion: Findings emphasize the magnitude of AI in pediatric rehabilitation and thus the importance of implement preventive strategies.Abbreviations: ADL: Activity of daily living; AI: Aggressive Incidents; CFCS: Communication Function Classification System; EVA: Recording aggressive incidents (Erfassung von Aggressionsereignissen); GMFCS: Gross Motor Function Classification System; MACS: Manual Ability Classification System; SOAS-R: Staff Observation of Aggression Scale-Revised; WeeFIM: Functional Independence Measure for Children; WPV: Workplace violence.


Assuntos
Agressão/psicologia , Reabilitação Neurológica/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Violência no Trabalho/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Fatores de Risco , Inquéritos e Questionários , Violência no Trabalho/psicologia
10.
Int J Med Inform ; 134: 104042, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31855847

RESUMO

PURPOSE: To investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients. METHODS: A retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay. RESULTS: A reduction in case-mix adjusted length of stay of 4.1 days per episode (95 % confidence interval: 2.0-6.4 days) was found. The corresponding reduction in hospital costs was estimated to be $3 738 per episode (95 % confidence interval $2 398-$4 983). CONCLUSIONS: Installation of electronic patient journey boards was associated with shorter lengths of stay in an inpatient adult rehabilitation centre. Additional research is needed to 1) provide further evidence of the causal effect of the boards on length of stay, and 2) investigate the mechanisms by which they reduce lengths of stay (e.g., increased currency of information, changes to procedures, remote viewing) in rehabilitation settings.


Assuntos
Apresentação de Dados/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Sistemas de Informação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitória
12.
BMC Public Health ; 19(1): 1742, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881994

RESUMO

BACKGROUND: Worldwide, fifteen percent (15%) of the world's population or one (1) billion people live with some form of disability. In Uganda, 12.4% of the Uganda's population lives with some form of disability and Kawempe division accounts for (22.6%) of all persons with disabilities living in Kampala district. Rehabilitation services are provided within Kawempe division at Mulago hospital physiotherapy department and Katalemwa rehabilitation center in Kampala district, Uganda at a free and a subsidized cost to help to improve the function, independence, and quality of life of persons with physical disabilities. However, many people with physical disabilities do not utilize the services and the reasons are not clear. METHODS: The study design was a descriptive cross-sectional study employing quantitative methods of data collection. A total of 318 participants were included in the study. Simple random sampling was used to select the study participants. Ethical issues were maintained at all levels during data collection and dissemination of results. RESULTS: The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Kampala, Uganda. Factors that were significantly associated with utilization of rehabilitation services among people with physical disabilities at multivariable logistic regression analysis included; age (AOR: 0.30; 95% CI: 0.12-0.74), socioeconomic status (AOR: 2.13; 95% CI: 1.03-4.41), education level (AOR: 4.3; 95% CI: 1.34-13.91) and awareness of the participants about the rehabilitation services (AOR: 5.1; 95% CI: 2.74-9.54) at p value ≤0.05. CONCLUSION: The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Uganda. Factors that were significantly associated with utilization of rehabilitation services included; age, socioeconomic status, education level and awareness of the participants about the services. Therefore, the government and other relevant stake holders should increase sensitization and awareness of rehabilitation services, their benefits and facilities providing such services to people with physical disabilities, healthcare professionals and the general public.


Assuntos
Pessoas com Deficiência/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores Socioeconômicos , Uganda/epidemiologia , Adulto Jovem
13.
Rev Assoc Med Bras (1992) ; 65(10): 1249-1253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721956

RESUMO

OBJECTIVE: In this study, we intend to identify the prevalence of clinical variables in children with microcephaly. METHODS: This is a cross-sectional and observational study with data collected from medical records of patients admitted to the microcephaly outpatient clinic of a referral center in Teresina-PI. Demographic (gender and age) and clinical data (presence of epilepsy, dysphagia, irritability, and associated comorbidities) were collected. The frequency of Zika virus as a probable etiology was determined from computed tomography patterns and the exclusion of other etiologies by serological tests. RESULTS: A total of 67 patient records were evaluated, of which 31 were male and 36 were female, with a mean age of 1 year and 10 months. The most prevalent clinical variables were epilepsy, present in 47 children (70.2%), and irritability in 37 (55.2%). Also with a high frequency, 22 had dysphagia (32.8%), and 13 had musculoskeletal comorbidities (19.4%). Only three patients in the sample had cardiac abnormalities (4.5%), and no endocrine comorbidity was found. A total of 38 children in the sample (56.7%) presented ZIKV as a probable etiology and, in these cases, there was a higher frequency of epilepsy and dysphagia compared to other etiologies, although not statistically significant. CONCLUSION: Epilepsy, irritability, dysphagia, and musculoskeletal comorbidities were the most frequent clinical variables in children with microcephaly. There was a high prevalence of congenital ZIKV microcephaly syndrome in this sample.


Assuntos
Epilepsia/epidemiologia , Microcefalia/virologia , Anormalidades Musculoesqueléticas/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Pré-Escolar , Comorbidade , Anormalidades Congênitas/epidemiologia , Anormalidades Congênitas/etiologia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Registros Médicos , Microcefalia/reabilitação , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Prevalência , Centros de Reabilitação , Estudos Retrospectivos , Infecção por Zika virus/congênito , Infecção por Zika virus/reabilitação
14.
Optom Vis Sci ; 96(10): 718-725, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31592954

RESUMO

SIGNIFICANCE: One-year follow-up is recommended for patients with macular diseases to assess functional changes associated with disease progression and to modify low-vision (LV) treatment plans, if indicated. PURPOSE: The purpose of this study was to observe 255 patients with macular diseases who received LV rehabilitation (rehabilitation with a therapist) or basic LV services (LV devices dispensed without therapy) during Veterans Affairs Low-vision Intervention Trial II after the trial ended at 4 months until 1-year follow-up. METHODS: The primary outcome measure was visual ability measured with the 48-item Veterans Affairs Low-vision Visual Functioning Questionnaire. Mean visual ability scores for the treatment groups were compared from baseline to 4 months, 4 months to 1 year, and baseline to 1 year. Changes from baseline to 1 year were compared between the two groups. Predictors of changes in visual ability from 4 months to 1 year were assessed using linear regression. RESULTS: Both groups experienced significant improvement in all measures of visual ability from baseline to 1 year but lost visual reading ability during the observation period (LV rehabilitation group, -0.64 [1.2] logit; 95% confidence interval [CI], -0.84 to -0.44 logit; basic LV group, -0.63 [1.4] logit; 95% CI, -0.88 to -0.38 logit), and overall visual ability was lost in the LV rehabilitation group (-0.20 [0.8] logit; 95% CI, -0.34 to -0.06 logit). Loss of visual reading ability in both groups from 4 months to 1 year was predicted by reading ability scores at 4 months, loss of near visual acuity from 4 months to 1 year, and lower EuroQol-5D utility index scores; loss of overall visual ability in the LV rehabilitation group during the same time period was predicted by lower overall ability scores at 4 months. CONCLUSIONS: Visual ability significantly improved in all groups from baseline to 1 year. However, the loss of visual reading ability experienced by both groups from 4 months to 1 year reduced the benefit of the services provided.


Assuntos
Doenças Retinianas/reabilitação , Veteranos/estatística & dados numéricos , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação , Doenças Retinianas/fisiopatologia , Perfil de Impacto da Doença , Inquéritos e Questionários , Resultado do Tratamento , Estados Unidos , United States Department of Veterans Affairs , Baixa Visão/fisiopatologia , Acuidade Visual/fisiologia
15.
Rehabilitation (Stuttg) ; 58(5): 339-350, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31645080

RESUMO

Multiple sclerosis is the most common cause of non-traumatic disability in young adults. The following article addresses special features of multiple sclerosis in the context of neurological rehabilitation. The rehabilitative and symptomatic therapy of frequent symptoms and functional deficits are presented independently of the course of the disease. Rehabilitation in MS focuses on functional deficits in mobility, paresis, spasticity, ataxia, bladder dysfunction, fatigue, cognitive symptoms, depression and pain. The multimodal inpatient rehabilitation comprises aerobic training in MS-specific groups and interventions targeting individual deficits. Neuropsychological training, individual and group session on coping and adherence to therapy as well as advice on social issues and the evaluation of the work place situation complement the therapy options. The early age of onset of the disease often causes an early restriction of participation in working life. The restoration and maintenance of work ability is therefore an essential goal of neurological rehabilitation, as well as the organization of aftercare and the introduction of vocational rehabilitation services.


Assuntos
Fadiga/complicações , Esclerose Múltipla/psicologia , Esclerose Múltipla/reabilitação , Reabilitação Neurológica/métodos , Atividades Cotidianas , Depressão/reabilitação , Alemanha , Humanos , Qualidade de Vida , Centros de Reabilitação , Resultado do Tratamento
16.
Am J Occup Ther ; 73(5): 7305205050p1-7305205050p9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484029

RESUMO

IMPORTANCE: Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services. OBJECTIVE: To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status. DESIGN: Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period. MEASURES: Admission measures included the Inpatient Rehabilitation Facility-Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care-Revised was administered after discharge. RESULTS: Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge. CONCLUSION: and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research. WHAT THIS ARTICLE ADDS: This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.


Assuntos
Terapia Ocupacional , Adulto , Análise por Conglomerados , Hospitalização , Humanos , Pacientes Internados/estatística & dados numéricos , Centros de Reabilitação , Resultado do Tratamento
17.
Urol Int ; 103(3): 350-356, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487741

RESUMO

PURPOSE: Early rehabilitation (ER) after radical cystectomy (RC) seems to be crucial for quality of life, education and prevention of complications after hospital discharge. We investigated an inpatient ER setting for bladder cancer (BC) patients. METHODS: In total, 103 BC patients who underwent ileum neobladder reconstruction were included. The major issues from the patients' point of view, functional outcome parameters and complications during ER were analysed. A Wilcoxon signed rank test was used to compare body mass index (BMI) and diurnal as well as nocturnal use of urinary pads before and after ER. RESULTS: At the beginning of ER, the median Karnovsky performance scale score was 70% (interquartile range [IQR] 70-90%) and the mean BMI was 25.8 kg/m2 (IQR 21.9-27.9). The 4 most common complaints were urinary incontinence (80.6%), general weakness (73.8%), urinary mucus (49.5%) and mental distress (44.7%). During the programme, 28.2% of patients had a urinary tract infection requiring antibiotics and 15.5% presented a symptomatic acidosis. Median diurnal use of urinary pads significantly decreased during ER (4 vs. 3; p < 0.001). At the end of the ER programme, 76.0, 54.8 and 30.8% of the patients indicated an improvement of their physical capacity, incontinence and psychological distress respectively. CONCLUSIONS: Our study demonstrates the need for postoperative rehabilitation after RC. Further investigations should compare outcome parameters to ambulatory and outpatient ER models.


Assuntos
Cistectomia/reabilitação , Íleo/cirurgia , Neoplasias da Bexiga Urinária/reabilitação , Neoplasias da Bexiga Urinária/cirurgia , Coletores de Urina , Idoso , Cistectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Centros de Reabilitação , Estudos Retrospectivos , Fatores de Tempo
18.
Medicine (Baltimore) ; 98(37): e17096, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517835

RESUMO

The aim of this study was to determine whether patients whose treatment is consistent with the 3-hour rule have better outcomes than patients whose treatment is not consistent with the 3-hour rule.This is a retrospective review of the records of 581 patients. The authors compared the outcomes of 397 patients whose therapy was consistent with the 3-hour rule to the outcomes of 184 patients whose therapy was not consistent with the rule for at least one 7-day period during the stay on an inpatient rehabilitation facility.Patients whose care was consistent with the rule did not have more improvement in function or shorter length of stay than patients whose care was not consistent with the 3-hour rule.There is not good evidence to support the 3-hour rule as a determinant of the care that a patient at an IRF needs to achieve a good outcome.


Assuntos
Centros de Reabilitação/estatística & dados numéricos , Centros de Reabilitação/normas , Fatores de Tempo , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação/organização & administração , Estudos Retrospectivos , Resultado do Tratamento
19.
J Pak Med Assoc ; 69(9): 1293-1299, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31511714

RESUMO

OBJECTIVE: To identify potential predictors of prolonged postpartum depression in mothers of children with physical disabilities. METHODS: The cross-sectional, correlational study was conducted at a paediatric neurodevelopmental rehabilitation centre in Peshawar, Pakistan, from December 9, 2016, to January 23, 2017, and comprised mothers of children with movement disorders born between January, 2014, and June, 2016. Prolonged postpartum depression was defined as onset of maternal depression between 6 and 36 months after birth. Edinburgh Postnatal Depression Scale was used with a cut-off score of 13/30, while a pretested questionnaire examined risk and protective factors predicting prolonged postpartum depression using binary logistic regression. SPSS 20 was used for data analysis. RESULTS: There were 171 subjects with a mean age of 27±6.4 years. Among them, prolonged postpartum depression was found in 95(55.6%). Six significant predictors of the condition were identified: supportive husband, child's disability having negative effect on social ties, daily physical help in childcare by at least one family member, pregnancy-induced hypertension, mother being blamed for child's disability, and financial problems (p<0.05 each). CONCLUSIONS: The identified predictors specific to local settings played a distinctive role in prolonged post-partum depression occurrence, particularly in the context of disability.


Assuntos
Paralisia Cerebral , Depressão Pós-Parto/psicologia , Status Econômico , Hipertensão Induzida pela Gravidez/epidemiologia , Mães/psicologia , Transtornos dos Movimentos , Apoio Social , Adolescente , Adulto , Pré-Escolar , Doença Crônica , Estudos Transversais , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Lactente , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Paquistão/epidemiologia , Escalas de Graduação Psiquiátrica , Centros de Reabilitação , Fatores de Risco , Cônjuges , Adulto Jovem
20.
Z Evid Fortbild Qual Gesundhwes ; 146: 35-42, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31558374

RESUMO

OBJECTIVE OF THE STUDY: The aim was to develop an evidence-based treatment concept which describes a standard of performance for stroke patients in neurological follow-up rehabilitation, contracted by a statutory health insurance agency. METHOD: The treatment concept was developed in several steps: a) first of all, a systematic literature search for guidelines was conducted and an online discussion forum was established, followed by b) formation of an expert group, as well as c) two expert workshops, two working groups and several written follow-up surveys. The implementation of the concept was scientifically accompanied by project team members from the eight pilot facilities selected. RESULTS: The treatment concept in its current version provides eleven modules, ten of which refer to the rehabilitation itself and one to the interface of acute care and rehabilitation. An innovative feature of this treatment concept is that the often contradictory demands for standardization and flexibility of individual cases according to the patients' needs are brought in line by freely selectable intensity standards. However, the commitment of a total minimum of therapy times is important. Since mid-March 2018, the treatment concept has been initially implemented in various pilot facilities occupied by the AOK Baden-Württemberg. CONCLUSION: The evidence-based and consensus-based concept is characterized by being individually and flexibly applicable to the individual patient. In this way, it meets the given demands and fulfils the requirements of a heterogeneous group of patients. It is intended to incorporate the treatment concept into the routine healthcare services offered by the AOK Baden-Württemberg. In addition, the treatment concept will be the basis for the development of performance-based remuneration.


Assuntos
Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Terapia Combinada , Alemanha , Humanos , Medicina , Equipe de Assistência ao Paciente , Centros de Reabilitação , Acidente Vascular Cerebral/complicações
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