Mobile health and supervised rehabilitation versus mobile health alone in breast cancer survivors: Randomized controlled trial

BackgroundSurvival rates in cancer are increasing exponentially, with a corresponding increase/influence in disability-adjusted life-years. Efforts should be made to explore the optimal balance between unsupervised/distance-based and supervised/onsite approaches to cancer care.ObjectiveThis study aimed to compare the clinical efficacy of the BENECA mobile Health (mHealth) lifestyle application combined with a supervised rehabilitation program (BENECA and supervised rehabilitation) versus the BENECA mHealth lifestyle application alone on quality of life (QoL) and functional outcomes of breast cancer survivors.MethodsThis randomized controlled trial included 80 survivors of breast cancer diagnosed at stage I–IIIA, who completed adjuvant therapy and were overweight or obese at diagnosis. Participants were randomly allocated (ratio 1:1, 3 waves) to BENECA mHealth and rehabilitation for 2 months (n = 40) or BENECA mHealth and usual care (BENECA mHealth alone; n = 40). Participants completed a questionnaire at baseline (T1), 8-weeks post-intervention (T2) and 6-month follow-up (T3). The primary outcome was QoL assessed with the EORT QLQ-C30. Secondary outcomes included upper-limb functionality and body composition. Statistical (between-group analyses of covariance) and clinical effects were analyzed by intention to treat.ResultsBoth groups showed improved outcomes, but global QoL was significantly better with BENECA mHealth and rehabilitation than BENECA mHealth alone (mean difference, 12.76; 95% confidence interval 4.85; 20.67; P = 0.004), with a moderate-to-large effect size (d = 72). The proportion of participants reporting reliable clinical improvement on global QoL at T2 was higher with BENECA mHealth and rehabilitation than BENECA mHealth alone (57.5% vs 26.3%, P = 0.008). Improvement in subjective and objective upper-limb functionality was also higher with BENECA mHealth and rehabilitation.ConclusionsThe BENECA mHealth lifestyle application with a supervised rehabilitation program had a statistically and clinically significant effect on QoL and upper-limb functionality in breast cancer survivors and is a unique and important promising new approach.     

An evaluation of a nurse-led rehabilitation programme (the ProBalance Programme) to improve balance and reduce fall risk of community-dwelling older people: A randomised controlled trial

ObjectiveThis study aims to assess the effect of a nurse-led rehabilitation programme (the ProBalance Programme) on balance and fall risk of community-dwelling older people from Madeira Island, Portugal.DesignSingle-blind, randomised controlled trial.SettingUniversity laboratory.Participants: Community-dwelling older people, aged 65–85, with balance impairments. Participants were randomly allocated to an intervention group (IG; n = 27) or a wait-list control group (CG; n = 25).InterventionA rehabilitation nursing programme included gait, balance, functional training, strengthening, flexibility, and 3D training. One trained rehabilitation nurse administered the group-based intervention over a period of 12 weeks (90 min sessions, 2 days per week). A wait-list control group was instructed to maintain their usual activities during the same time period.OutcomeBalance was assessed using the Fullerton Advanced Balance (FAB) scale. The time points for assessment were at zero (pre-test), 12 (post-test), and 24 weeks (follow up).ResultsChanges in the mean (SD) FAB scale scores immediately following the 12-week intervention were 5.15 (2.81) for the IG and −1.45 (2.80) for the CG. At follow-up, the mean (SD) change scores were −1.88 (1.84) and 0.75 (2.99) for the IG and CG, respectively. The results of a mixed between-within subjects analysis of variance, controlling for physical activity levels at baseline, revealed a significant interaction between group and time (F (2, 42) = 27.89, p < 0.001, Partial Eta Squared = 0.57) and a main effect for time (F (2, 43) = 3.76, p = 0.03, Partial Eta Squared = 0.15), with both groups showing changes in the mean FAB scale scores across the three time periods. A significant main effect comparing the two groups (F (1, 43) = 21.90, p < 0.001, Partial Eta Squared = 0.34) confirmed a clear positive effect of the intervention when compared to the control.ConclusionThis study demonstrated that the rehabilitation nursing programme was effective in improving balance and reducing fall risk in a group of older people with balance impairment, immediately after the intervention. A decline in balance was observed for the IG after a period of no intervention.Clinical Trial Registration NumberACTRN12612000301864.     

Local vibration training improves the recovery of quadriceps strength in early rehabilitation after anterior cruciate ligament reconstruction: A feasibility randomised controlled trial

BackgroundAfter anterior cruciate ligament reconstruction (ACLR), quadriceps strength must be maximised as early as possible.ObjectivesWe tested whether local vibration training (LVT) during the early post-ACLR period (i.e., ～10 weeks) could improve strength recovery.MethodsThis was a multicentric, open, parallel-group, randomised controlled trial. Thirty individuals attending ACLR were randomised by use of a dedicated Web application to 2 groups: vibration (standardised rehabilitation plus LVT, n = 16) or control (standardised rehabilitation alone, n = 14). Experimenters, physiotherapists and participants were not blinded. Both groups received 24 sessions of standardised rehabilitation over ～10 weeks. In addition, the vibration group received 1 hour of vibration applied to the relaxed quadriceps of the injured leg at the end of each rehabilitation session. The primary outcome — maximal isometric strength of both injured and non-injured legs (i.e., allowing for limb asymmetry measurement) — was evaluated before ACLR (PRE) and after the 10-week rehabilitation (POST).ResultsSeven participants were lost to follow-up, so data for 23 participants were used in the complete-case analysis. For the injured leg, the mean (SD) decrease in maximal strength from PRE to POST was significantly lower for the vibration than control group (n = 11, ?16% [10] vs. n = 12, ?30% [11]; P = 0.0045, Cohen's d effect size = 1.33). Mean PRE–POST change in limb symmetry was lower for the vibration than control group (?19% [11] vs. ?29% [13]) but not significantly (P = 0.051, Cohen's d effect size = 0.85).ConclusionLVT improved strength recovery after ACLR. This feasibility study suggests that LVT applied to relaxed muscles is a promising modality of vibration therapy that could be implemented early in ACLR.Trial registrationClinicalTrials.gov: NCT02929004.     

Cardiac rehabilitation availability and delivery in Brazil: a comparison to other upper middle-income countries

BackgroundBrazil has insufficient cardiac rehabilitation capacity, yet density and regional variation in unmet need is unknown. Moreover, South America has CR guidelines, but whether delivery conforms has not been described.ObjectiveThis study aimed to establish: (1) cardiac rehabilitation volumes and density, and (2) the nature of programmes, and (3) compare these by: (a) Brazilian region and (b) to other upper middle-income countries (upper-MICs).MethodsIn this cross-sectional study, a survey was administered to cardiac rehabilitation programmes globally. Cardiac associations were engaged to facilitate programme identification. Density was computed using Global Burden of Disease study ischaemic heart disease incidence estimates. Results were compared to data from the 29 upper-MICs with cardiac rehabilitation (N = 249 programmes).ResultsCardiac rehabilitation was available in all Brazilian regions, with 30/75 programmes initiating a survey (40.0% programme response rate). There was only one cardiac rehabilitation spot for every 99 ischaemic heart disease patient. Most programmes were funded by government/hospital sources (n = 16, 53.3%), but in 11 programmes (36.7%) patients depended on private health insurance. Guideline-indicated conditions were accepted in ≥70% of programmes. Programmes had a team of 3.8 ± 1.9 staff (versus 5.9 ± 2.8 in other upper-MICs, p < 0.05), offering 4.0 ± 1.6/10 core components (versus 6.0 ± 1.5 in other upper-MICs, p < 0.01; more tobacco cessation and return-to-work counselling needed in particular) over 44.5 sessions/patient (Q25–75 = 29–65) vs. 32 sessions/patient (Q25–75 = 15–40) in other upper-MICs (p < 0.01).ConclusionBrazilian cardiac rehabilitation capacity must be augmented, but where available, services are consistent across regions, but differ from other upper-MICs in terms of staff size and core components delivered.     

Effect of individualized coaching at home on walking capacity in subacute stroke patients: A randomized controlled trial (Ticaa’dom)

BackgroundThe gains in walking capacity achieved during rehabilitation often plateau, or are lost, when the patient returns home. Moreover, maintaining or increasing the patient's daily physical activity level after a stroke remains challenging. We aimed to evaluate the effectiveness of a six-month individualized coaching program at home on walking capacity, as evaluated by the six-minute walk test in subacute stroke patients.MethodsStroke patients in the physical medicine and rehabilitation service participated in a monocentric observer blinded randomized controlled trial with two groups, intervention versus usual care control. The inclusion criteria were: age ≥ 18 years, first ischemic or hemorrhagic stroke, and stroke within < 6 months. Participants were randomly assigned (blocks of variable size) to an intervention group (EG) receiving individualized coaching on physical activity, or to a control group (CG) receiving standard care. The six-month program was composed of monitored physical activity, home visits and a weekly phone call. Participants were evaluated after hospital discharge (T0), at the end of the six-month program (T1) and six months later(follow-up; T2). The primary outcome was the walking distance performance, as evaluated with the six-minute walk test at T1.ResultsEighty-three participants (age: 61y [IQR = 22]; time post-stroke: 2.4 month [IQR = 1.7]; Barthel index: 100[IQR = 5]) were included in the study: (EG, n = 41; CG, n = 42). The difference between the two groups was not significant at T1(418 m [IQR = 165] for the EG and 389 m [IQR = 188] for the CG; P = 0.168) and at T2(425 m [IQR = 121] for the EG vs. 382 m [IQR = 219] for the CG; P = 0.208).ConclusionOur study shows no difference in the six-minute walk test between the two groups of subacute stroke patients after 6 months of the individualized coaching program, combining home visits, feedback on daily performance and weekly telephone calls. http://ClinicalTrials.gov (NCT01822938).     

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation,cross-cultural adaptation and reliability

BackgroundThe Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries.ObjectivesTo translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency.Methodsthis study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil.ResultsTranslation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n = 107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n = 50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n = 92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n = 62).ConclusionThe Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.     

Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial

BackgroundLittle evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls.ObjectiveTo compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality.DesignRandomised experimental trial.SettingA 3000-bed medical centre in northern Taiwan.ParticipantsPatients with hip fracture aged 60 years or older (N = 299).MethodPatients were randomly assigned to three groups: comprehensive care (n = 99), interdisciplinary care (n = 101), and usual care (control) (n = 99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients’ self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission.ResultsThe comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up.ConclusionComprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care.     

Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind,randomised, controlled trial

BackgroundUpper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).ObjectiveThis was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.MethodsWe randomized 45 patients with acute stroke into 2 groups (conventional therapy, n = 22, and RAT, n = 23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.ResultsIn total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P = 0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P = 0.02) and patient social participation (Stroke Impact Scale +18%; P = 0.01). Participants’ abilities to perform manual activities and activities of daily living improved similarly in both groups.ConclusionFor the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.     

Short-term effects of a 3-week interval training program on heart rate variability in chronic heart failure. A randomised controlled trial

BackgroundExaggerated sympathetic nervous system activity associated with low heart rate variability (HRV) is considered to trigger cardiac arrhythmias and sudden death. Regular exercise training is efficient to improve autonomic balance.ObjectiveWe aimed to verify the superiority of high-intensity interval training (HIIT) to enhance HRV, cardiorespiratory fitness and cardiac function as compared with moderate intensity continuous training (MICT) in a short, intense cardiac rehabilitation program.MethodsThis was a prospective, monocentric, evaluator-blinded, randomised (1:1) study with a parallel two-group design. Overall, 31 individuals with voluntary chronic heart failure (CHF) (left ventricular ejection fraction [LVEF] < 45%) were allocated to MICT (n = 15) or HIIT (n = 16) for a short rehabilitation program (mean [SD] 27 [4] days). Participants underwent 24-hr electrocardiography, echocardiography and a cardiopulmonary exercise test at entry and at the end of the study.ResultsHigh-frequency power in normalized units (HFnu%) measured as HRV increased with HIIT (from 21.2% to 26.4%, P < 0.001) but remained unchanged with MICT (from 23.1% to 21.9%, P = 0.444, with a significant intergroup difference, P = 0.003). Resting heart rate (24-hr Holter electrocardiography) decreased significantly for both groups (from 68.2 to 64.6 bpm and 66.0 to 63.5 bpm for MICT and HIIT, respectively, with no intergroup difference, P = 0.578). The 2 groups did not differ in premature ventricular contractions. Improvement in peak oxygen uptake was greater with HIIT than MICT (+ 21% vs. + 5%, P = 0.009). LVEF improved with only HIIT (from 36.2% to 39.5%, P = 0.034).ConclusionsIn this short rehabilitation program, HIIT was significantly superior to the classical MICT program for enhancing parasympathetic tone and peak oxygen uptake.ClinicalTrials.gov identifierNCT03603743     

Decrease in post-stroke spasticity and shoulder pain prevalence over the last 15 years

ObjectivesThe usual complications after recent stroke such as disabling spasticity and shoulder pain seemed less frequent in recent years. This study examined the frequency of spasticity and shoulder pain in recent post-stroke patients over time in our physical and rehabilitation medicine department.MethodsThis was a retrospective study of post-stroke inpatients over the last 15 years. Spasticity and shoulder pain prevalence were analyzed, as were demographic, clinical and stroke characteristics.ResultsWe reviewed medical records for 786 patients (506 men); mean age 58.1 years (SD 13.2); 530 (68%) with ischemic stroke and 256 (32.36%) hemorrhagic stroke. After a first increase from 2000 to 2006, the prevalence of disabling spasticity decreased from 2006 to 2015 (31%–10%; P < 0.001). Shoulder pain at admission and during hospitalization also decreased (13% of patients in 2000 to 8% in 2015, P < 0.001). Disabling spasticity was associated with shoulder pain (26% of patients with disabling spasticity presented shoulder pain at admission vs 7% with hyperreflexia of the deep tendon reflexes, P < 0.05). Characteristics of stroke, time of admission after stroke and length of stay did not change over the years. We observed an increase in number of walking patients at admission and number with a functional paretic arm at admission and discharge (P < 0.05), which may explain the increase in functional independence measure scores at admission and discharge (both P < 0.05). Prevalence of cognitive disorders increased over the same period (24% in 2000 vs 63% in 2015, P < 0.05).ConclusionsDisabling spasticity and shoulder pain frequency in recent post-stroke patients decreased over the last 15 years, and functional abilities both at admission and discharge improved. Confirmation of these results in a multicentric study may be important evidence of an improvement in stroke healthcare both in stroke and physical and rehabilitation medicine units in the last 10 years in France and could affect future estimations of the need for rehabilitation care after stroke.     

Prediction equation of hip external rotators maximum torque in healthy adults and older adults using the measure of hip extensors maximum torque

BackgroundThe use of predictive equation of muscular torque can reduce physical effort and time spent during evaluation.ObjectivesTo establish, validate, and test the accuracy of a prediction equation to estimate the hip external rotators (HER) torque in adults and older adults by means of hip extensors (HEX) torque measurement.MethodsEighty-three healthy adults (development set) were assessed to test the association of HEX and HER torques and to establish the prediction equation. A separate 36 adults and 15 older adults (validation sets) were assessed to test the ability of the equation to estimate HER torque. Hip isometric strength was assessed by a handheld dynamometer.ResultsSimple linear regression analysis revealed that HEX torque was associated with HER torque (r = 0.80; p < 0.0001), resulting in the following prediction equation: HER_torque= −0.02 + (0.58 * HEX_torque). Paired t-test revealed no difference between directly measured and predicted values of HER torque in adults (mean difference = 0.02; 95% CI = −0.115, 0.072) and older adults (mean difference = 0.05; 95% CI = −0.02, 0.12).ConclusionThe HEX and HER torques were strongly correlated. The prediction equation was valid, accurate, and can be used to estimate HER muscle strength in healthy adults and older adults, requiring only the direct measurement of HEX torque.     

Correlations of creatine and six related pyrimidine metabolites and diabetic nephropathy in Chinese type 2 diabetic patients

ObjectivesThe assessment of the clinical significance of creatine, cytosine, cytidine, uridine, thymine, thymidine, and 2′-deoxyuridine concentrations in patients with type 2 diabetes mellitus (T2DM) and diabetic nephropathy (DN) for the detection of the relationship between pyrimidine metabolites and disease.Design and methodsThe study group consisted of 119 subjects, which were divided to three groups: control (n = 31), type 2 diabetes without nephropathy (DM, n = 23), and with nephropathy (DN, n = 65). Levels of related metabolites were measured in plasma of all participants.ResultsThere is a significant increase in levels of cytosine (P < 0.001), cytidine (P < 0.001), and thymidine (P = 0.016) with DN compared to DM. The levels of uridine, thymine, 2′-deoxyuridine, and creatine did not change.ConclusionsThe levels of cytosine, cytidine, and thymidine may be useful for monitoring the progression of DM and evaluating the treatment.     

EMG breakthrough during cortical silent period in congenital hemiparesis: a descriptive case series

BackgroundThe cortical silent period is a transient suppression of electromyographic activity after a transcranial magnetic stimulation pulse, attributed to spinal and supraspinal inhibitory mechanisms. Electromyographic breakthrough activity has been observed in healthy adults as a result of a spinal reflex response within the cortical silent period.ObjectivesThe objective of this case series is to report the ipsilesional and contralesional cortical silent period and the electromyographic breakthrough activity of 7 children with congenital hemiparesis.MethodsTMS was delivered over the ipsilesional and contralesional primary motor cortices with resting motor threshold and cortical silent period measures recorded from first dorsal interosseous muscle.ResultsSeven children (13 ± 2 years) were included. Ipsilesional and contralesional resting motor thresholds ranged from 49 to 80% and from 38 to 63% of maximum stimulator output, respectively. Ipsilesional (n = 4) and contralesional (n = 7) cortical silent period duration ranged from 49 to 206 ms and 81 to 150 ms, respectively. Electromyographic breakthrough activity was observed ipsilesionally in 3/4 (75%) and contralesionally in 3/7 (42.8%) participants. In the 3 children with ipsilesional breakthrough activity during the cortical silent period, all testing trials showed breakthrough. Contralesional breakthrough activity was observed in only one of the analyzable trials in each of those 3 participants. The mean peak amplitude of breakthrough activity ranged from 45 to 214 μV (ipsilesional) and from 23 to 93 μV (contralesional).ConclusionFurther research is warranted to understand the mechanisms and significance of electromyographic breakthrough activity within the cortical silent period in congenital hemiparesis. Understanding these mechanisms may lead to the design of tailored neuromodulation interventions for physical rehabilitation.Trial registrationNCT02250092 (https://clinicaltrials.gov/ct2/show/NCT02250092)     

Rehabilitation of 190 non-ambulatory children with cerebral palsy in structures of care or in liberal sector

AimsTo describe the rehabilitation of non-ambulatory children with cerebral palsy and to explore adjustability on their individual needs.Material and methodData described are extracted from an on-going national cohort study, following during 10 years 385 children with cerebral palsy, aged from 4 to 10, Gross Motor Function Classification System IV and V. We analysed data from the first 190 patients (mean age 6 years 10 months (SD 2.0), 111 boys), focusing on physiotherapy, ergotherapy, psychomotility and speech therapy in medico-social and liberal sectors.ResultsIn medico-social sector, duration of paramedical care is significantly more important than in liberal sector (structure of care: median = 4.25 h/week, liberal sector: median = 2.00 h/week) (P < 0.0001). More than 4 different types of care per week are given in medico-social sector, while in liberal sector children benefit from only 2 different types of care a week. In investigators opinion, rehabilitation in structures of care is 71.65% adapted as opposed to 18.75% in the liberal sector (P < 0.001). Children level V have less time of rehabilitation than the others (P = 0.0424).InterpretationRehabilitation of children with cerebral palsy who are not able to walk, with an objective to improve quality of life, is truly multidisciplinary and suitable in medico-social sector.     

Feeding Tubes and Health Costs Postinsertion in Nursing Home Residents With Advanced Dementia

ContextThe best evidence suggests that feeding tubes are ineffective in persons with advanced dementia. Little is known about their health care costs.ObjectivesTo estimate Medicare costs attributable to inpatient care among nursing home (NH) residents with advanced dementia during the year following the placement of a percutaneous endoscopic gastrostomy (PEG) tube during an index hospitalization.MethodsMedicare claims (1999–2009) and Minimum Data Set data (1999–2009) were used to estimate Medicare costs attributable to inpatient care among NH residents with advanced dementia during the year following the placement of a PEG tube and compared with those who did not get a PEG tube. The study used a 3:1 propensity-matched cohort design.ResultsMatched residents with (n = 1924, 68.9% female, 28.8% African American, average age 83.1 years) and without (weighted n = 1924, unique n = 4337) PEG insertion showed comparable sociodemographic characteristics, similar rates of feeding tube risk factors, and similar mortality (51.9% 180 day mortality among those with a feeding tube vs. 49.8% among those without a feeding tube, P = 0.11). One year hospital costs were $2224 higher in NH residents with a feeding tube ($10,191 vs. $7967, 95% CI of difference = $1514, $2933), with those with a feeding tube likely to spend more time in an intensive care unit (1.92 vs. 1.29 days, 95% CI of difference = 0.34, 0.92 days).ConclusionIn an analysis controlling for selection bias, PEG tube insertion is associated with a small but significant increase in annual inpatient health care costs, as well as in hospital and intensive care unit days, postinsertion.     

Health Related Quality of Life and support needs for sub-arachnoid haemorrhage survivors in New South Wales Australia

BackgroundSubarachnoid haemorrhage (SAH) is commonly a devastating injury with long lasting physical and psychosocial consequences for survivors. Support after hospital discharge through chronic care services for this patient group is limited. This study aimed to measure Health Related Quality of Life (HRQoL) and needs of survivors after discharge from hospital.MethodsA population of patients that were diagnosed with SAH were contacted, up to 2 years post discharge, to participate in a postal survey including the Short Stroke Specific Quality of Life Scale (SSQoL-12), a service utilisation questionnaire and attitudes towards participating in a support group.FindingsThere were 28 responders. HRQoL was lowest in the psychosocial domain and particularly in relation to fatigue and memory. Most notably many responders indicated they wanted to be interviewed but a support group was not favoured with few responders (n = 11) indicating interest with most in favour of a face to face format (n = 10).ConclusionsHRQoL was reduced particularly in the psychosocial domain. Although there was low utilisation of support services in the post-acute care phase, these patients may benefit from greater opportunities to participate in both physical and psychosocial rehabilitation programs.     

Prevalencia de trastornos del sueño y factores asociados en pacientes hospitalizados

ObjectiveTo determine the prevalence of insomnia in inpatient in an Internal Medicine Department and to identify risk factors of sleep disorders.MethodA cross-sectional observational study was designed. Inpatients over eighteen years old hospitalized for acute medical conditions were recruited. Insomnia was assessed by the Athens insomnia scale. A nurse administered a questionnaire on risk factors including socio-demographic factors, reason for admission, comorbidities, current medications, functional status, nocturnal symptoms, and environmental factors.ResultsA total of 299 patients were recruited with a mean age of 73.7 years (SD 14.2). Overall prevalence of insomnia was 42.1%, slightly higher in women (48.2%) than in men (37.0%) (P = .052). In those less than 65 years the prevalence was 33.8%, and in patients aged 65 or over it was 44.9% (P = .093). The main factors associated with insomnia were a history of anxiety, depression and stroke, heartburn, pain, fear, and poor functional capacity at admission. Environmental factors such as noise, the sensation of cold or heat, and changing habits involved in hospitalization did not reach statistical significance. In patients 65 years or older, the use of beta-blockers was associated with insomnia. The multivariate analysis showed stroke, heartburn, and pain as independent risk factors for insomnia.ConclusionsInsomnia is highly prevalent among inpatient, and is associated with some treatable or modifiable factors.     

Impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults: A Quasi-experimental study

BackgroundWith an aging population, it is critical that nurses are educated and prepared to offer quality healthcare to this client group. Incorporating gerontology content into nursing curricula and addressing students' perceptions and career choices in relation to working with older adults are important faculty concerns.ObjectivesTo examine the impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults and career intentions.DesignQuasi-experimental, pre- and post-test design.SettingMedium-sized state university in the Mid Western United StatesParticipantsData were collected from three student cohorts during the spring semesters of 2012 (n = 98), 2013 (n = 80) and 2014 (n = 88) for a total of N = 266 with an average response rate of 85%.MethodsA survey instrument was administered via Qualtrics and completed by students prior to, and following completion of the course.ResultsThere was an overall significant increase (p = 0.000) in positive perceptions of working with older adults among nursing students following completion of the course. The majority of participants (83.5%) reported having previous experience with older adults. Those with previous experience had higher perception scores at pre-test than those without (p = 0.000). Post-test scores showed no significant difference between these two groups, with both groups having increased perception scores (p = 0.120). Student preferences for working with different age groups suggested an overall increase in preference for working with older adults following the course.ConclusionsA course in gerontological nursing, incorporating learning partnerships with community dwelling older adults, promotes positive perceptions of working with older adults, independently of the quality of prior experience. There was some evidence that students changed their preferences of working with different age groups in favor of working with older adults. Further research should be conducted to determine the mechanisms through which this takes place.     

Oxidative stress and DNA damage in older adults that do exercises regularly

ObjectivesFree radicals may damage lipids, proteins and DNA, which may lead to critical diseases in the aging. This work evaluated levels of malondialdehyde (MDA), glutathione peroxidase (GPx) and DNA damage by comet assay (SCGE) in older adults that do exercises regularly.Design and Methods110 females, aged 66.3 ± 8 years were divided into sedentary (n = 54), walking (n = 36) and muscle building (n = 20) groups. Levels of MDA, GPx and SCGE were measured in venous blood before and after exercise.ResultsMDA levels were higher (P < 0.005) and GPx levels were lower (P < 0.005) in active groups than in sedentary group. SCGE index after physical activity was greater than at baseline (muscle building: P = 0.004; walking: P = 0.002).ConclusionsExercise reduces the diseases risk, but may promote the production of free radicals. It remains unclear whether cell adaptations responsible for health benefits are associated with such events. However we may suggest the existence of a different biochemical pattern for older adults that do exercise regularly.     

Survey of parental acceptance of massage therapy,energy therapy and acupuncture for their children in the acute pediatric inpatient rehabilitation setting

ObjectiveTo examine factors that influence parents' decision to accept or decline complementary therapies on an inpatient rehabilitation unit.Design/SettingParents of children aged 2–21 admitted for acute pediatric rehabilitation were provided a survey regarding their child's use of massage, energy therapy and acupuncture during admission. They were also asked about religious beliefs, education, perceived severity of injury and perceived response to the therapies. The study was conducted on the Inpatient Acute Pediatric Rehabilitation Unit at Kennedy Krieger Institute in Baltimore, Maryland, USA.ResultsOf those who completed the survey (n = 38), 39% accepted massage services, 49% accepted energy therapy, and 16% accepted acupuncture for their child. Acceptance of massage services was significantly correlated with belonging to an organized religion (p < 0.05). Participation in weekly religious services was associated with rejection of energy therapy (p < 0.01). Prior parental experience with massage and acupuncture was associated with acceptance of these services for their child (p < 0.01). Chronicity of condition and family education was not related to acceptance or rejection of services. Over 80% of parents felt massage and energy therapy helped the recovery process. In 63% of parents surveyed, acupuncture was felt to help the recovery process.ConclusionsPrior exposure to massage therapy and acupuncture was the most important factor in a parent accepting these services for their child. All three services were subjectively felt to have facilitated recovery. Future studies should assess subjective versus objective utility of these therapies in acute pediatric rehabilitation.