The Association of Changes in Physical Performance During Geriatric Inpatient Rehabilitation With Short-Term Hospital Readmission,Institutionalization, and Mortality: RESORT

ObjectivesGeriatric inpatient rehabilitation aims to restore function, marked by physical performance, to enable patients to return and remain home after hospitalization. However, after discharge some patients are soon readmitted, institutionalized, or may die. Whether changes in physical performance during geriatric rehabilitation are associated with these short-term adverse outcomes is unknown. This study aimed to determine the association of changes in physical performance during geriatric inpatient rehabilitation with short-term adverse outcomes.DesignObservational longitudinal study.Setting and ParticipantsGeriatric rehabilitation inpatients of the REStORing health of acutely unwell adulTs (RESORT) cohort study of the Royal Melbourne Hospital (Melbourne, Australia) were included.MethodsThe change from admission to discharge in the Short Physical Performance Battery (SPPB) score, balance, gait speed (GS), chair stand test (CST), and hand grip strength (HGS) were calculated and analyzed using logistic regression analysis with readmission, incidence of institutionalization, and mortality, and ≥1 adverse outcome within 3 months postdischarge.ResultsOf 693 inpatients, 11 died during hospitalization and 572 patients (mean age 82.6 ± 7.6 years, 57.9% female) had available physical performance data. Within 3 months postdischarge, 47.3% of patients had ≥1 adverse outcome: readmission was 20.8%, institutionalization was 26.6%, and mortality was 7.9%. Improved SPPB score, balance, GS, CST, and HGS were associated with lower odds of institutionalization and mortality. Improved GS was additionally associated with lower odds of readmission [odds ratio (OR) 0.35, 95% CI 0.16-0.79]. CST score had the largest effect, with a 1-point increase associating with 40% lower odds of being institutionalized (OR 0.60, 95% CI 0.42-0.86), 52% lower odds of mortality (OR 0.48, 95% CI 0.29-0.81), and a 24% lower odds of ≥1 adverse outcome (OR 0.76, 95% CI 0.59-0.97).Conclusions and ImplicationsImprovement in physical performance was associated with lower odds of short-term institutionalization and mortality indicating the prognostic value of physical performance improvement during geriatric inpatient rehabilitation.     

早期康复在脑卒中偏瘫治疗中的作用

目的　探讨早期康复在急性脑卒中偏瘫患者肢体运动功能和日常生活能力恢复方面的作用。方法选择首次发病的急性脑卒中偏瘫患者 2 0 0例 ,随机分为康复组和对照组 (每组 10 0例 )。治疗组在给予神经科常规治疗的同时分别给予正规的康复治疗 ,对照组仅给予神经科常规治疗。分别于康复治疗前当天和治疗后 6周进行测评。测评内容包括肢体运动功能和日常生活活动能力 (ADL)。结果　经 6周治疗后 ,肢体运动功能评分 (FMA)、ADL(Barthel指数 )两组均有明显改善 ,其中康复组改善程度明显优于对照组 (P <0 .0 1)。结论　早期康复能明显改善脑卒中偏瘫患者肢体运动功能和日常生活活动能力。     

居家模拟培训对老年髋关节置换患者康复效果的影响

目的探讨开展居家模拟培训提高老年髋关节置换患者康复的效果。方法按住院时间将老年髋关节置换患者162例分为对照组80例和观察组82例,对照组采取骨科常规护理方式进行康复指导,观察组在常规护理基础上由高级责任护士实施全程居家生活与出行路径的模拟培训。于入院时、术后1个月、3个月、6个月评价两组Harris髋关节功能评分与Barthel指数。结果观察组Harris髋关节功能评分及Barthel指数评分显著高于对照组(均P<0.01)。结论开展居家模拟培训有利于促进老年髋关节置换术后患者康复,提高日常生活能力。     

Esofaguectomía «tubeless»: menos es más

The esophageal cancer surgery is a complex procedure with elevated rates of both morbidity and mortality, which is why, in order to achieve adequate results, it should be performed in high volume centers, where complete multidisciplinary support is available and recent clinical guidelines are applied. We describe the initial experience and the technique of “tubeless” esophagectomy where esophageal resection and mediastinal lymphadenectomy are performed and no drains nor tubes of any kind are placed, with the aim to decrease the level of surgical aggression, enhance the postoperative comfort and accelerate the patient?s recovery.     

High-intensity interval training can improve hand grip strength,inspiratory muscle,and quality of life in systemic sclerosis subjects

IntroductionSystemic sclerosis/scleroderma (SSc) is a chronic autoimmune disease with connective tissue, multi-organ, and multisystem involvement. The disease has three main characteristics, namely vasculopathy, fibrosis, and autoimmunity. The effect of high-intensity interval training (HIIT) in aerobic exercise on other rheumatic diseases has been studied, for example in patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). The purpose of this work is to investigate the effectiveness of HIIT of aerobics exercise on improving the inspiratory muscle, quality of life and functional ability for systemic sclerosis subjects.Material and methodsThe study was conducted on patients with confirmed systemic sclerosis who met the inclusion criteria. The research was carried out for 12 months in the outpatient clinic and gait laboratory of the Department of Physical Medicine and Rehabilitation.ResultsAfter HIIT in aerobic exercise, we found significant changes in inspiratory muscle (SNIP values 45.67 [30.92] vs. 54.25 [22.71]), handgrip (13.14 [4.42] vs. 15.63 [4.08]), walking speed (184.70 [26.86] vs. 246.6 [12.30]), metabolic equivalent (3.53 [0.30] vs. 4.21 [1.25]) and Scleroderma-Specific Health Assessment Questionnaire Disability Index for all visual analog scale (VAS) domains except Disability Index. Exercise approaches are characterized by repeated cycles of exercise interrupted by rest. For a range of clinical conditions, HIIT in aerobic exercise is known to remedy blood vessel function.ConclusionsOur results suggest that HIIT in aerobic exercise has improved functional ability, respiratory muscle strength, and quality of life in SSc subjects. Training twice a week in a 12-week HIIT program is considered to be safe for this population. We have to consider internal and external factors that influenced the result. A larger sample and further exploration of the feasibility of combined exercise in SSc patients should be the focus for future research.     

微课指导下呼吸训练对肺癌根治术后肺功能的影响

目的 分析微课指导下呼吸训练对肺癌根治术后肺功能的影响。方法 选取本院2016年1月—2018年1月收治的120例肺癌患者,以随机数字表法分为A组60例、B组60例,A组实施常规呼吸训练,B组在A组基础上给予微课指导,对比两组生活质量评分及肺功能指标。结果 B组术后第一秒最大呼出总量(FEV1)、用力深呼吸时肺活量(FVC)及FEV1/FVC分别为(2.08±0.29)L、(3.15±0.41)L、(69.78±12.55),高于A组的(1.74±1.14)L、(2.01±0.56)L、(64.44±12.02),(P<0.05);B组术后生活质量中社会领域、环境领域、生理症状、心理状态评分分别为(16.71±3.71)分、(17.99±3.36)分、(14.97±2.32)分、(16.44±3.85)分,高于A组的(13.58±3.45)分、(15.21±3.45)分、(13.12±2.64)分、(13.45±3.44)分,(P值均<0.05)。结论 微课指导下呼吸训练可有效改善肺癌根治术后肺功能指标及提高生存质量。