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1.
Willi Horner-Johnson Gloria L. Krahn Rie Suzuki Jana J. Peterson Gale Roid Trevor Hall RRTC Expert Panel on Health Measurement 《Archives of physical medicine and rehabilitation》2010,91(4):570-575
Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.
Objective
To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.Design
Survey responses were analyzed by using partial correlations.Setting
General community.Participants
Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.Interventions
Not applicable.Main Outcome Measure
SF-36.Results
Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.Conclusions
Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36. 相似文献2.
Yokoyama O Sakuma F Itoh R Sashika H 《Archives of physical medicine and rehabilitation》2006,87(9):1189-1194
Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.
Objective
To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).Design
Case-controlled study.Setting
SCI unit in a rehabilitation center.Participants
Seventeen patients with SCI-AA and 17 patients with traumatic SCI.Intervention
Standard rehabilitation therapy for SCI.Main Outcome Measures
Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.Results
No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.Conclusions
SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community. 相似文献3.
Tyng-Guey Wang Yeun-Chung Chang Wen-Shiang Chen Pei-Hung Lin Tzu-Yu Hsiao 《Archives of physical medicine and rehabilitation》2010,91(6):926-931
Wang T-G, Chang Y-C, Chen W-S, Lin P-H, Hsiao T-Y. Reduction in hyoid bone forward movement in irradiated nasopharyngeal carcinoma patients with dysphagia.
Objective
To quantitatively assess the movement of the hyoid bone and pyriform sinus stasis in irradiated nasopharyngeal carcinoma (NPC) patients suffering from dysphagia.Design
Retrospective data analysis.Setting
A tertiary teaching hospital.Participants
NPC subjects (n=33, 25 men and 8 women) and healthy subjects (n=10, 7 men and 3 women) participated in the study.Intervention
Videofluoroscopic swallowing study (VFSS) of all subjects.Main Outcome Measures
The displacement and velocity of hyoid bone movement, the amount of pyriform sinus stasis, and the widest opening distance of the cricopharyngeal muscle during swallowing.Results
The displacement of the hyoid bone in the NPC patients was significantly less than that of the healthy subjects (1.58±0.59 vs 2.23±0.49cm, P=.0033). The displacement of the hyoid bone was divided into forward and vertical directions, and the forward displacement in the NPC patients was found to be less than that of the healthy subjects (0.85±0.50 vs 1.65±0.51cm), achieving statistic significance (P<.0001). The pyriform sinus stasis of the NPC subjects was significantly more than that of the healthy subjects (2.24±0.98 vs 0.30±0.17cm2, P<.0001). The movement velocity of the NPC subjects was less than that of the healthy subjects (2.49±1.41 vs 5.10±0.85cm/s, P=.0086). Furthermore, the NPC subjects with aspiration experienced less displacement of the hyoid bone than those without aspiration (1.23±0.45 vs 1.76±0.58cm, P=.029).Conclusion
The irradiated NPC subjects with dysphagia experienced a reduction in hyoid bone displacement, occurring in a forward direction. The displacement of the hyoid bone was less in the aspiration subjects than in those without aspiration. 相似文献4.
Marques CJ Cabri J Barreiros J Carita AI Friesecke C Loehr JF 《Archives of physical medicine and rehabilitation》2008,89(5):851-855
Marques CJ, Cabri J, Barreiros J, Carita AI, Friesecke C, Loehr JF. The effects of task complexity on brake response time before and after primary right total knee arthroplasty.
Objective
To study the effects of an increase in task complexity on brake response time (BRT) in patients undergoing total knee arthroplasty (TKA).Design
A prospective repeated-measures design was used. The measurements took place 1 day before and 10 and 30 days after surgery.Setting
Clinic.Participants
The data of patients (N=21) who were admitted for primary total arthroplasty of the right knee were pooled for analysis.Interventions
On each measurement day patients performed 5 practice and 10 test trials for 2 tasks (1 simple, 1 complex) in a car simulator. Task complexity was increased by adding a second movement to the first task performed.Main Outcome Measures
BRT, reaction time (RT), and movement time were assessed.Results
An increase in task complexity increased BRT, RT, and movement time at all measurement times. Right TKA increased BRT by increasing movement time. Thirty days after surgery BRT was no longer increased compared with preoperative values in both tasks.Conclusions
Task complexity consistently increased BRT and its components. The effects of task complexity remained constant throughout the 3 measurements. After right TKA, we suggest patients should be advised to wait 30 days after surgery before resuming driving. 相似文献5.
James H. Frisbie G.V.R.K. Sharma 《Archives of physical medicine and rehabilitation》2009,90(7):1241-1244
Frisbie JH, Sharma GVRK. Right bundle branch block as a screening test for pulmonary embolism in chronic spinal cord injury.
Objectives
To evaluate right bundle branch block (RBBB) on electrocardiograms (ECGs) as a screening tool for the diagnosis of pulmonary embolism (PE) in a chronic spinal cord injury (SCI) population and to determine the prevalence of PE.Design
Retrospective analysis.Setting
Boston Veterans Affairs Healthcare System.Participants
Consecutive SCI participants (N=112) who were followed at this institution until death between 1999 and 2005 at an average age of 71 years, a duration of paralysis of 31 years, with a tetraplegic level in 62%, and no useful motor function in 84%.Intervention
Not applicable.Main Outcome Measures
PE, as a cause of RBBB, was diagnosed by autopsy, a source of thromboembolism, imaging, or other ECG signs of PE. Chronic obstructive lung disease was diagnosed by pulmonary function tests and myocardial infarction by ECG or echocardiogram.Results
Twenty-nine participants (26%) had RBBB (6 with incomplete RBBB). Evidence that PE caused RBBB was found in 21 (72%), with 4 (3 massive) found by autopsy, 4 by the presence of an embolic source, 3 by imaging, 2 by the intermittent course of RBBB, 1 by abrupt onset of RBBB before death, and 7 by other ECG signs. RBBB represented chronic obstructive lung disease or myocardial infarction in the remaining 8. The onset of RBBB occurred either within months of SCI in 5 (1 before SCI) or years after SCI in 24 (6-50y, median 32y). RBBB was constant in 27 and intermittent in 2. The duration of RBBB ranged from 20 minutes to 31 years, median 4 years.Conclusions
RBBB may be a useful initial screening test for PE complicating chronic SCI. PE, often recurrent and sometimes fatal, is prevalent in chronic SCI. 相似文献6.
Somnath Datta Douglas J. Lorenz Sarah Morrison Elizabeth Ardolino Susan J. Harkema 《Archives of physical medicine and rehabilitation》2009,90(7):1208-1217
Datta S, Lorenz DJ, Morrison S, Ardolino E, Harkema SJ. A multivariate examination of temporal changes in Berg Balance Scale items for patients with ASIA Impairment Scale C and D spinal cord injuries.
Objective
To provide a multivariate examination of the Berg Balance Scale (BBS) in patients with spinal cord injury (SCI) as a first step in developing a balance tool for the SCI population.Design
Observational cohort.Setting
The NeuroRecovery Network (NRN), a specialized network of treatment centers providing standardized, activity-based therapy for patients with SCI.Participants
Patients (N=97) with American Spinal Injury Association Impairment Scale C or D SCI who were enrolled in the NRN between March 1, 2005, and June 12, 2007.Interventions
All enrolled patients received 3 to 5 locomotor training sessions a week, according to NRN protocol, and were periodically evaluated for progress on functional outcome measurements.Main Outcome Measures
Scores on the items of the BBS, six-minute walk test distances, ten-meter walk test speeds, and scores on the SCI Functional Ambulation Index. Temporal rates of change of the BBS items were examined with a principal components and correlation analysis.Results
The first principal component accounted for nearly half of the overall variability in the BBS, correlated well with rates of change in functional mobility measures, and had good stability in its composition as verified by a resampling analysis. Further analysis showed that the composition of the first principal component varied with the patient's level of recovery.Conclusions
The BBS captures a significant amount of information about balance recovery in persons with SCI and may be a good foundation for a balance tool. However, the utility of BBS items may be dependent on a patient's level of recovery. A dynamic balance instrument for the SCI population may be needed. 相似文献7.
Sumiko Shiba Hiroyuki Okawa Hiroyasu Uenishi Yumi Koike Katuya Yamauchi Ko Asayama Taro Nakamura Fumihiro Tajima 《Archives of physical medicine and rehabilitation》2010,91(8):1262-1266
Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.
Objective
To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).Design
Longitudinal study (20-y follow-up).Setting
Laboratory setting.Participants
Persons with SCI (N=7).Interventions
Not applicable.Main Outcome Measures
Maximum oxygen consumption V?o2max) measured in 1986-1988 and in 2006.Results
Subjects with SCI maintained stable V?o2max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o2max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o2max by 43% and 45% after 20 years.Conclusion
The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities. 相似文献8.
Su-Ju Tsai Tsung-Ho Ying Yu-Hui Huang Ju-Wen Cheng Liu-Ing Bih Henry L. Lew 《Archives of physical medicine and rehabilitation》2009,90(5):832-348
Tsai S-J, Ying T-H, Huang Y-H, Cheng J-W, Bih LI, Lew HL. Transperineal injection of Botulinum Toxin A for treatment of detrusor sphincter dyssynergia: localization with combined fluoroscopic and electromyographic guidance.
Objective
To determine the effectiveness of a combined method for localizing external urethral sphincter for transperineal injection of botulinum toxin A (BTX-A) in the treatment of detrusor sphincter dyssynergia (DSD) in patients with spinal cord injury (SCI).Design
A prospective, open-label trial.Setting
A rehabilitation hospital affiliated with a medical university.Participants
Eighteen SCI patients with voiding dysfunction resulting from urodynamically confirmed DSD.Interventions
100 units of BTX-A injected transperineally into the external urethral sphincter, which was localized using combined fluoroscopic and electromyographic guidance, using a Foley catheter inserted for visualization of vesicourethral anatomy.Main Outcome Measures
(1) postvoid residual volume, (2) leak point pressure, (3) maximal intravesical pressure, (4) maximal urethral pressure, (5) quality of life measures for urination, quantified by the Quality of Life Index (QLI).Results
Positive clinical outcomes were observed in all 18 patients in this study. The mean reductions in postvoid residual volume, leak point pressure, maximal intravesical pressure, and maximal urethral pressure before and after BTX-A injection were 183ml, 37cm H2O, 45cm H2O, and 92cm H2O, respectively (all P values <.05). The mean QLI significantly improved from −0.68±0.27 to 0.66±0.19 (P<.01). No significant side effects were noted after injection. The clinical therapeutic effects have shown reductions in occurrence and degree of autonomic dysreflexia, vesicoureteral reflux, hydronephrosis, and urinary tract infection. The bladder management programs also obtained improvements in our patients, either doing intermittent catheterizations less frequently, or resuming spontaneous voiding without indwelling catheters.Conclusion
With this combined method for localization of the external urethral sphincter, transperineal injection of BTX-A was safe, accurate, easy to perform, and effective for treatment of DSD in patients with SCI. 相似文献9.
Claire Z. Kalpakjian Elisabeth H. Quint Tamara Bushnik Gianna M. Rodriguez Melissa Sendroy Terrill 《Archives of physical medicine and rehabilitation》2010,91(4):562-569
Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury.
Objective
To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI).Design
Prospective cohort (4 data collection periods across 4 years).Setting
Community.Participants
Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed.Interventions
None.Main Outcome Measures
Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms).Results
The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness.Conclusions
Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition. 相似文献10.
Anthony C. Waddimba Nitin B. Jain Kelly Stolzmann David R. Gagnon James F. Burgess Jr Lewis E. Kazis Eric Garshick 《Archives of physical medicine and rehabilitation》2009,90(2):193-200
Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury.
Objective
To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized.Design
Prospective cohort study.Setting
Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts.Participants/Data Sources
Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database.Interventions
Not applicable.Main Outcome Measures
Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression.Results
Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4kg/m2). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors.Conclusions
Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations. 相似文献11.
Evadne G Marcolini Jay R Bradshaw EMT-P Michael R Baumann MD 《Prehospital emergency care》2004,8(1):23
Objective
To study utilization, indications, and outcomes associated with the use of a statewide, emergency medical services (EMS) standing-order protocol for cricothyrotomy.Methods
A statewide EMS database was queried for patients who received cricothyrotomy under a standardized, standing-order protocol. Patient EMS and hospital records were reviewed in a defined sequence with information recorded on a standardized collection form.Results
EMS records included eight years of practice with 1.5 million patient encounters. For each year studied, approximately 540 emergency medical technicians (EMTs) were certified to perform cricothyrotomy. State EMS providers performed a collective mean of eight cricothyrotomy procedures per year (range, 1-17), for a total of 68 cricothyrotomies performed within the eight-year period. Hospital records were available for review in 61 patients. Fifty-six patients received cricothyrotomy by open surgical incision, six by needle with jet ventilation, and one by both methods. Categorization of cricothyrotomy patients as trauma or medical was 61% trauma and 39% medical. Thirty-six patients (59%) were in cardiac arrest on EMS arrival and 12 patients (20%) died during transport. Thirteen trauma patients (21%) were admitted with eight patients surviving to discharge (13%). The neurologic impairment at time of hospital discharge was severe in four, moderate in two, and minimal or none in two patients (3%).Conclusion
A considerable percentage of cricothyrotomy procedures were performed on patients with non-trauma-related diagnoses in this investigation describing a standing-order EMS protocol for cricothyrotomy. The majority of patients undergoing cricothyrotomy with this protocol were in cardiac arrest at the time of cricothyrotomy, with a small minority of patients surviving to hospital discharge and fewer surviving neurologically intact. 相似文献12.
Noonan VK Kopec JA Zhang H Dvorak MF 《Archives of physical medicine and rehabilitation》2008,89(6):1074-1082
Noonan VK, Kopec JA, Zhang H, Dvorak MF. Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome.
Objective
To determine the effect of associated spinal cord injury (SCI) conditions on the health status and quality of life (QOL) in people with traumatic central cord syndrome.Design
Cross-sectional design.Setting
Community-based.Participants
Subjects (N=70) with traumatic central cord syndrome who were a minimum of 2 years postinjury.Interventions
Not applicable.Main Outcome Measures
Presence of associated SCI conditions (neuropathic pain, spasticity, bowel, bladder, and/or sexual dysfunction, decreased motor function); health status (36-Item Short-Form Health Survey [SF-36], symptom satisfaction); and QOL.Results
The SF-36 physical component score (PCS) was lower in subjects who reported problems with bowel, bladder, and/or sexual function (−6.9; 95% confidence interval [CI], −11.6 to −2.2). The PCS was decreased in subjects with a lower motor score and this relationship was negatively affected by spasticity and being less educated. The SF-36 mental component score was negatively affected by neuropathic pain and a lower motor score. Neuropathic pain and a lower motor score were both associated with subjects being dissatisfied with their symptoms. Subjects who had a higher motor score were more likely to have a higher QOL (odds ratio, 1.7; 95% CI, 1.1 to 2.7).Conclusions
The associated SCI conditions bowel, bladder, and/or sexual dysfunction, neuropathic pain, decreased motor function, and spasticity negatively affect the health status of persons with traumatic central cord syndrome. Diminished motor recovery was the only associated SCI condition to impact QOL. By developing a conceptual model and adjusting for confounders, an estimate for each associated SCI condition's effect on patient outcomes was obtained. Our results indicate the importance of treating or ameliorating associated SCI conditions in order to maximize physical and mental functioning. 相似文献13.
Johann Szecsi Martin Schiller Andreas Straube Dieter Gerling 《Archives of physical medicine and rehabilitation》2009,90(4):564-570
Szecsi J, Schiller M, Straube A, Gerling D. A comparison of functional electrical and magnetic stimulation for propelled cycling of paretic patients.
Objective
To compare isometric torque and cycling power, smoothness and symmetry using repetitive functional magnetic stimulation (FMS) and functional electrical stimulation (FES) in patients with paretic legs with preserved sensibility and in patients without sensibility.Design
Repeated-measures design.Setting
Laboratory setting.Participants
Eleven subjects with complete spinal cord injury (SCI) and 29 subjects with chronic hemiparesis (16.6±5.5mo poststroke) volunteered.Interventions
Using a tricycle testbed, participants were exposed to isometric measurements and ergometric cycling experiments, performed during both 20Hz FMS and FES stimulation. Subjects with hemiparesis and with complete SCI were stimulated at maximally tolerable level and maximal intensity, respectively.Main Outcome Measures
Maximal isometric pedaling torque and mean ergometric power, smoothness, and symmetry were recorded for voluntary, FES, and FMS conditions.Results
Two different patterns of the efficacy of FMS were identified. (1) Patients with complete SCI did not benefit (less torque and power was evoked with FMS than with FES, P<.003 and 10−4 respectively). (2) Patients with hemiplegia and preserved sensibility could improve their torque output (P<.05), smoothness, and symmetry of pedaling (P<.05) with FMS more than with FES.Conclusions
FMS is a potential alternative to surface FES of the large thigh musculature in stimulation-supported cycling of patients with partially or completely preserved sensibility. 相似文献14.
Background
Cachexia in advanced malignancy is a debilitating syndrome which contributes to approximately two million deaths worldwide annually. In spite of advances in understanding the biomedical aspects of cancer cachexia, little attention has been paid to exploring its holistic impact on patients and those who care for them.Objective
The aim of this paper is to describe the lived experience of cachexia from the perspective of patients with cancer and their family members.Design
An interpretative phenomenological approach was employed.Setting and participants
A purposive sampling strategy recruited 15 patients and 12 family members from the Regional Cancer Centre in Northern Ireland.Method
Each participant was interviewed during 2004/2005 using an unstructured interview. All interviews were recorded and transcribed verbatim. Analysis combined a two stage approach using thematic and interpretative phenomenological analysis.Results
Analysis generated six superordinate themes that reflected the complex dynamics of the cachexia experience. Themes were: physiological changes in appetite; visuality of cachexia; weight loss interpreted as a bad sign; response from health care professionals; conflict over food; and coping responses.Conclusions
Findings confirmed that cancer cachexia has far reaching implications for patients and their families, extending beyond physical problems into psychological, social and emotional issues. This insight is a critical first step in the development of more responsive care for these clients. 相似文献15.
Mary Ann Regan Robert W. Teasell Dalton L. Wolfe David Keast William B. Mortenson Jo-Anne L. Aubut Spinal Cord Injury Rehabilitation Evidence Research Team 《Archives of physical medicine and rehabilitation》2009,90(2):213-231
Regan MA, Teasell RW, Wolfe DL, Keast D, Mortenson WB, Aubut JL, for the Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury.
Objective
To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI).Data Sources
For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO.Study Selection
To be selected for inclusion in the current review, there had to have been an intervention, studies had to have 3 or more subjects, and 50% or more of the participating group had to have an SCI.Data Extraction
Data extracted included study design, subject demographics, inclusion and exclusion criteria, study type, sample size, outcome measures used, and study results.Data Synthesis
Articles selected for this review were organized into 1 of 2 categories: prevention or treatment. Within each broad category, several smaller ones were created, and articles were grouped according to the prevention (direct or indirect) or treatment intervention discussed.Conclusions
Of the 26 articles selected for inclusion in the systematic review, 7 were randomized controlled trials (RCTs) that dealt with treatment for pressure ulcers, and there was 1 RCT on prevention. Despite the cost-effectiveness of prevention, little research exists on preventative interventions, and what does exist is mostly level 4 evidence. More research is needed for both prevention and treatment, but especially the former. 相似文献16.
van den Berg-Emons RJ Bussmann JB Haisma JA Sluis TA van der Woude LH Bergen MP Stam HJ 《Archives of physical medicine and rehabilitation》2008,89(11):2094-2101
van den Berg-Emons RJ, Bussmann JB, Haisma JA, Sluis TA, van der Woude LH, Bergen MP, Stam HJ. A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge.
Objectives
To assess the change over time in the physical activity level after a spinal cord injury (SCI), to explore its determinants, and to compare the physical activity level 1 year after discharge from the rehabilitation center with the level in able-bodied persons.Design
Prospective cohort study. Measurements were obtained at the start of active rehabilitation, 3 months later, at discharge, 2 months after discharge, and 1 year after discharge.Setting
Rehabilitation center in The Netherlands and the participant's home.Participants
Persons (n=40) with SCI.Interventions
Not applicable.Main Outcome Measures
The physical activity level, as indicated by the duration of dynamic activities (ie, wheelchair driving, walking, cycling, noncyclic movement) per day, and the intensity of everyday activity; both were measured with an accelerometry-based activity monitor during 2 consecutive weekdays.Results
Random coefficient analyses showed that the duration of dynamic activities and the intensity of everyday activity increased during inpatient rehabilitation at rates of 41% and 19%, respectively (P<.01). Shortly after discharge, there was a strong decline (33%; P<.001) in the duration of dynamic activities. One year after discharge, this decline was restored to the discharge level but was low in comparison with levels in able-bodied persons. The level of lesion and completeness of lesion were determinants of the change in the physical activity level after discharge.Conclusions
The physical activity level increased during inpatient rehabilitation, but this increase did not continue after discharge, and the level 1 year after discharge was distinctly lower than the level in able-bodied persons. Subpopulations had a different change over time in the physical activity level after discharge. 相似文献17.
Gergely Mincsovics 《International journal of nursing studies》2009,46(7):903-911
Background
Understanding the quality loss implications of short staffing is essential in maintaining service quality on a limited budget.Objectives
For elaborate financial control on staffing decisions, it is necessary to quantify the cost of the incidental quality loss that a given workload and staffing level entail.Design
We develop a quantitative methodology that uses a quality loss function to support staffing decisions. Loss function candidates are compared based on their mean squared error of retest.Data source
Our methodology is presented on previously collected data on the nursing service of an adolescent mental health unit. This data was used to test commonly used hypotheses on the quality loss function.Results
A quality-centred methodology was developed to support daily staffing decisions, creating a synthesis of the literature on quality and workload measurement based on operations research techniques. For quality loss function development, the quadratic form hypothesis resulted in a mean squared error of 10.93, the patient-to-nurse ratio hypothesis was 8.27, and the ridge estimator was 7.04.Conclusions
Using proper data collection, quality data can help in making rational staffing decisions via the development of a quality loss function. Our tests indicate that the quadratic form hypothesis on the quality loss function is weak, whereas the patient-to-nurse hypothesis has potential for practical use. 相似文献18.
Davood Hekmatpou Fazlollah Ahmadi Sayed Hassan Arefi 《European Journal of Cardiovascular Nursing》2009,8(5):355-363
Background
Readmission due to congestive heart failure is a global problem during the recent decades; however, little is known about the process of readmission in these patients.Aim
To clarify the readmission process of patients suffering from congestive heart failure in two large referral hospitals in Tehran, Iran.Method
A grounded theory approach was utilized. 42 experienced patients, families, nurses and cardiologists participated in the study. Data analysis was carried out over a period of 12 months (November 2007 to November 2008).Results
The main concern of participants was “managing the acute problems” of disease. The process of readmission begins with “concentrating on the concern”. So, all the participants neglected the patient readmission. Having managed the acute problems, the patients were discharged without a “comprehensive context oriented discharge planning” leading to their return to community without preparation or supporting system. This results in “traditional self-treatment” owing to unhealthy behaviors which brings about the readmission of patients. Neglecting or “lack of sensitivity to readmission” was presented as the core variable.Conclusion
In order to control readmission, we recommend those in charge of policy-making for public health to pay particular attention to this variable and taking step such as sensitizing people concerned. 相似文献19.
Laird BJ Scott AC Colvin LA McKeon AL Murray GD Fearon KC Fallon MT 《Journal of pain and symptom management》2011,42(1):1-11
Context
Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.Objective
This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.Methods
Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.Results
Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).Conclusion
Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning. 相似文献20.
Li-Chun Chang 《International journal of nursing studies》2010,47(4):427-433