局部应用苯妥英治疗各类创口效果的系统评价

目的探讨局部应用苯妥英治疗各类创口的有效性和安全性.方法计算机检索MEDLINE(1966～2002.10)、EMBASE(1984～2002.10)、Cochrane 图书馆(2002年第4期)、Biologic Abstract(1993～1996)、Cancerlit(1997～2002.9)、Life Science Collection(1982～1995.3)、The International Pharmaceutical Abstract(1970～2002)和中国生物医学文献数据库(1978～2003.1),收集局部应用苯妥英治疗各类创口的对照试验.逐篇评价纳入研究的质量后,对研究结果进行描述性分析.结果共纳入9篇文献(1篇RCT、8篇同期非随机对照研究),共507例各类创口.文献质量评价结果显示,纳入文献的方法学质量均较低.多数研究的结果表明,局部应用苯妥英在健康肉芽组织的生长、痊愈率、痊愈时间以及降低创口细菌培养阳性率方面较对照药疗效好,但由于各种创口形成原因、对照干预措施以及结局评价指标上存在差异,未能进行Meta分析.仅一个研究报道有轻微的不良反应.结论评价者认为纳入论证强度低于随机对照试验的研究,其结论可能引起误导,因此要得出苯妥英治疗各类创口肯定有效的结论,尚需进行更多设计、执行和报告都良好的随机对照试验.     

心脏康复训练对冠心病患者生活质量的影响

目的探讨护士指导与支持下的病人自我管理型家庭心脏康复训练对改善冠心病患者生活质量的效果.方法将167名符合纳入与排除标准的冠心病患者随机分配到干预组与对照组.对照组84例接受常规治疗护理,干预组83例接受为期12周的患者自我管理型家庭心脏康复训练,包括药物管理、心绞痛管理、运动锻炼、饮食管理、戒烟等.生活质量用SF-36中文版测评.资料收集时间为干预前、干预后,以及干预结束后3个月随访时.结果接受心脏康复训练的干预组患者在一般健康状况、生理机能、生理职能、躯体疼痛、心理健康和精力方面的改善均显著优于对照组.三个月后随访时,其生理功能和生理职能的改善亦显著优于对照组.结论护士指导与支持下的患者自我管理型家庭心脏康复训练对改善冠心病患者的生活质量有积极作用.     

A realist study of the mechanisms of cardiac rehabilitation

AIM: The aim of this paper is to report patients' experiences of cardiac rehabilitation and perceptions of the mechanisms and contexts influencing its long-term effectiveness. BACKGROUND: Cardiac rehabilitation programmes for the secondary prevention of coronary heart disease are common. The effects of these programmes, however, can be inconsistent and little is known of the personal and contextual factors that influence service effectiveness. METHOD: Forty-seven participants with a formal diagnosis of coronary heart disease who had attended a programme of cardiac rehabilitation in Scotland 3 years previously were included in focus groups to discuss their perceptions and experiences (30 males and 17 females). The data were generated in 2002 and analysed using the realist approach of Pawson and Tilley (1997). RESULTS: Participants' accounts indicated that the didactic content of cardiac rehabilitation was not strongly linked to longer-term health behaviour change. The main positive effects of cardiac rehabilitation were related to the effect of participation on mediating social and body-focused mechanisms that were triggered when the rehabilitation setting was perceived to be safe. Social mechanisms identified included social comparisons, camaraderie, and social capital. Body-focused mechanisms included greater knowledge of personal physical boundaries and a greater trust in the heart-diseased body. Collectively, these mechanisms had a positive effect on confidence that was perceived as being imperative to maintain health behaviour change. CONCLUSIONS: More support is required to promote health behaviour change after the completion of cardiac rehabilitation. Use of community-based exercise services and conventional or web-based support groups for coronary heart disease patients should be encouraged, as these appear to extend the positive health effects of the mechanisms that promote behaviour change. At the completion of cardiac rehabilitation programmes, patients should be referred to safe and appropriate community-based exercise services. Further research is needed to examine the effects on health outcomes of mechanisms and contexts related to cardiac rehabilitation.     

The use of guided imagery to manage pain in an elderly orthopaedic population

BACKGROUND: The management of postoperative pain in elderly orthopaedic patients is critical for advancing patient outcomes and improving the use of healthcare resources. Adequate pain control without adverse side effects, such as confusion and sedation, is crucial to promote comfort and participation in rehabilitation therapies among all patients but particularly among elderly joint replacement patients. Without adequate pain control, physical therapy is delayed and the risk of complications increases. One area of investigation that holds promise for improved treatment outcomes involves the use of complementary therapies, such as guided imagery. PURPOSE: The purpose of this pilot study was to test the effects of a guided imagery intervention in the older adult patient who has undergone joint replacement surgery. SAMPLE AND METHODS: This pilot study used a two-group experimental repeated measures design. A sample of 13 patients, age 55 years and older, were recruited. The control group received usual care and a music audio tape. The experimental group received usual care and a guided imagery audio tape intervention. FINDINGS AND DISCUSSION: Trends in this pilot study demonstrated positive outcomes for pain relief, decreased anxiety, and decreased length of stay. Complementary therapy holds the promise of increasing positive outcomes. Further research is needed to validate these findings with a larger postoperative sample and in other populations as well. CLINICAL IMPLICATIONS: There is a critical need to incorporate the use of guided imagery and other complementary therapies into all nursing curricula. Nurses must develop expertise and be ready and able to act as patient educators and advocates in the use of these interventions in programs of care and institutional policy.     

Education and support for the newly diagnosed cardiac family: a vital link in rehabilitation

In eastern Canadian small cities, community programming for cardiac rehabilitation is in its infancy. As professional awareness of the special needs of cardiac clients has grown, some components of cardiac rehabilitation programmes have developed, albeit autonomously from one another, e.g. in-hospital education, home visiting, exercise programmes, and support groups. Attempts are being made to establish communication channels among the health personnel involved in the different agencies in order to achieve a better availability and coordination of services for the benefit of cardiac clients and their families. To address needs arising after the first hospitalization or first diagnosis of cardiac disease, an education and support programme has been established by a university nursing faculty through the efforts of its junior students. This programme takes the form of 8-week series of informal classes. Objectives, methods and outcomes are outlined. Some recommendations for future community cardiac rehabilitation efforts emerge from clinical practice and programme evaluation. Implications for health professionals in such future activities are discussed.     

Reorganization of nursing and medical care to reduce the incidence of postoperative delirium and improve rehabilitation outcome in elderly patients treated for femoral neck fractures

The aim of this study was to evaluate the effectiveness of a nursing and medical intervention programme for the prevention and treatment of delirium in elderly patients treated for femoral neck fractures. Forty-nine patients consecutively admitted to an orthogeriatric rehabilitation unit in a county hospital in northern Sweden were compared with historical cohorts of corresponding patients in the same and other hospitals. There was a total reorganization of nursing and medical care of patients with femoral neck fractures. The intervention programme consisted of staff education, co-operation between orthopaedic surgeons and geriatricians, individual care and planning of rehabilitation, improved ward environment, active nutrition, improved continuity of care and prevention and treatment of complications associated with delirium. The main result of the study was that the incidence of delirium was significantly lower than in all previously published studies. The incidence of other postoperative complications was also lower, and a larger proportion of the patients regained independent walking ability and could return to their previous living conditions on discharge. It can be concluded that the intervention programme reduced the incidence and duration of delirium and improved functional outcome for elderly patients treated for femoral neck fractures.     

Are older patients’ cardiac rehabilitation needs being met?

Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme. Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake. Design. Mixed methods. Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face‐to‐face audio‐taped interview. Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’. Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed. Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.     

Cardiac rehabilitation and quality of life: a systematic review

ObjectiveThe objective of this systematic review was to explore the effects of cardiac rehabilitation interventions on the quality of life of patients with coronary heart disease with a specific focus on interventions that could be delivered within the context of a publicly funded health service.DesignSystematic review of trials reporting quality of life data as an outcome measure. Electronic databases (CINAHL, MEDLINE and PsycINFO) were searched from 1 January 1999 to 25 November 2010 in the English language. Inclusion criteria were: randomised controlled trials of cardiac rehabilitation as configured for a publicly funded health service. Data were extracted by one reviewer and checked by a second reviewer.ResultsThe 16 papers reported RCTs conducted in nine countries. Fifteen measurement instruments were utilised to measure quality of life across the different studies precluding a meta-analysis. Four themes emerged from the thematic analysis of the selected papers: physical well-being (including fitness and symptoms); psychological well-being (including anxiety and depression); social well-being (including family life and relationships); and functional status (including return to work and previous life style). Physical domain outcomes suggest that cardiac rehabilitation may improve physical well-being and levels of physical activity and thereby improved levels of physical fitness. Both physical and psychological domain outcomes suggest that home-based interventions are at least as effective as centre-based interventions. Relatively few trials reported on quality of life within the social domain and any difference between centre-based and home-based interventions appeared to favour the home-based intervention.ConclusionsThis review indicates that cardiac rehabilitation improves the quality of life for coronary heart disease patients and that quality of life improvements have a bi-directional relationship with increased physical activity and vocational status. Further research is needed to explore the relationship of quality of life outcomes to cardiac mortality, the relationship between improved physical well-being and anxiety, and the quality of life and mortality effects of cardiac rehabilitation in older people.     

Re-engineering cardiac rehabilitation programmes: considering the patient's point of view

AIMS: The aim of this paper is to report a study to describe how cardiac patients experience the first 3 months following a cardiac event requiring hospitalization, identify differences between the needs expressed by patients and the support they received during their recuperation and produce a preliminary model for the development of cardiac rehabilitation programmes, taking into account the patient perspective. BACKGROUND: Although cardiac rehabilitation should be standard care for patients with cardiovascular disease, less than 20% begin and maintain a rehabilitation programme. Cited barriers include inadequate rehabilitation services, sub-optimal referral, low participation rates of women and older adults and travel considerations. The literature suggests that programmes better adjusted to patient needs could increase attendance, but little research has considered this perspective. METHODS: Focus groups were conducted with a purposefully selected sample of 20 men and women who had been hospitalized for myocardial infarction, angina or percutaneous angioplasty. Data were analysed using qualitative content analysis. FINDINGS: A gap exists between what traditional rehabilitation programmes offer and patients' expressed needs during the recuperating process after hospitalization for a cardiac event. In our study, participants focused on stress management rather than on modifying health habits. Support groups were viewed as beneficial and, according to patients, accepting their condition, knowing their limits and better continuity of care would also help reduce stress. Based on the findings, we devised a model as the basis for developing cardiac rehabilitation programmes. CONCLUSION: Cardiac rehabilitation programmes need to shift their focus of attention from promoting healthier behaviours to responding to participants' perceived needs, alongside risk factor reduction.     

Cardiac rehabilitation vs. home exercise after coronary artery bypass graft surgery: a comparison of heart rate recovery

OBJECTIVE: The autonomic dysfunction is known to adversely affect clinical outcome in patients with cardiovascular disease, and exercise training has been shown to modify the sympathovagal control of heart rate. The purposes of this study were to investigate the effect of cardiac rehabilitation on heart rate recovery in patients who received coronary artery bypass grafting (CABG) and compare the effect with that of a home-based exercise program. DESIGN: Fifty-four male patients having undergone CABG were randomly assigned to a cardiac rehabilitation exercise program (n = 18), a home-based exercise program (n = 18), and a control group (n = 18) for 12 wks to evaluate the differences in heart rate recovery among groups. RESULTS: Patients in the cardiac rehabilitation group had significant increases in heart rate recovery (19.1 +/- 6.2 vs. 14.0 +/- 5.4 beats/min, P = 0.022) compared with those in the control group. There were no significant differences in heart rate recovery between cardiac rehabilitation and home-based exercise groups (16.2 +/- 4.8 beats/min) or between home-based exercise and control groups. All three groups had significantly improved heart rate recovery compared with their baseline data (P < 0.001, < 0.001, and 0.007). CONCLUSION: Our results point out that a cardiac rehabilitation exercise program has a positive effect on heart rate recovery in patients having undergone CABG and is consistent with the autonomic improvement. Although the home-based exercise group did not reveal statistical significances over those in the control group, it had comparable efficacy to that demonstrated in the cardiac rehabilitation group.     

Acceptance and disclosure of HIV status through an integrated community/home-based care program in South Africa

AIM: To report the outcome of a comparative study among people living with HIV/AIDS (PLWHAs) served by an integrated community/home-based care (ICHC) programme and those who are not in any home-based care programme in terms of acceptance and disclosure of the HIV status. BACKGROUND: One of the major challenges in HIV/AIDS care in developing countries is acceptance and disclosure of a positive HIV status by PLWHAs. Denial and non-disclosure of HIV status hinders prevention efforts as well as access to treatment, care and support for PLWHAs. METHODS: Quantitative data were collected in 2004 from a group of PLWHAs served by the ICHC programme and a group that was not receiving any community/home-based care. Data were compared between the two groups in terms of acceptance and disclosure of HIV status. FINDINGS: The ICHC was effective in improving acceptance and disclosure of the HIV-positive status by PLWHAs in the programme. PLWHAs in the ICHC programme did not find disclosure of their status difficult, and had disclosed their positive HIV status to more people than those who are not in any programme. PLWHAs in the ICHC programme not only disclosed their positive HIV status within their family network and households, but also disclosed to the community in general, sports group, religious groups and other social networks. CONCLUSIONS: Community/home-based care programmes can serve as catalysts for acceptance and disclosure of a positive HIV status by PLWHAs.     

Nursing needs of hospitalized older adults. Consumer and nurse perceptions

The proportion of older adults is increasing in Australia, and the proportion of older adults requiring medical care is expected to increase in the future. At the same time, budget restrictions are a reality for Australia's health system. Increasing need and decreasing resources suggest the need to focus on the quality aspect of treatment and care for older adults. Little research has been conducted in the area of perceived nursing needs of elderly patients during hospitalization. This is an important area of research because it is increasingly recognized that elderly patients have specialized needs and are the major consumers of health care. Even less research has compared patient and carer perceptions with those of nursing staff. This article is a literature review and an investigation of the quality of care elderly patients receive, and of patient and nurse perceptions of the importance of various nursing activities. Quality of care is reviewed in terms of perceptions of nursing care priorities and elderly patients' satisfaction with the quality of nursing care they receive. Research examining nurses' perceptions related to why they are unable to consistently provide quality nursing care to all elderly patients is also reviewed. By identifying the nursing needs of elderly patients and educating nursing staff about these needs, professional practice can be guided and improvements in quality of care, patient satisfaction, and patient outcomes may occur.     

Improvement of worklife participation through vocationally oriented cardiac rehabilitation? Findings of a randomized control group study

PURPOSE: Although acute medical care of cardiac patients has clearly improved, vocational integration and vocational outlook of patients after MI and/or cardiac surgery did not improve substantially over the last few decades. This study is intended to evaluate a programme aimed at enhancing the return to work of cardiac rehabilitands. The programme is applied in addition to the usual rehabilitation programme and includes job-related interventions by the Social and Psychological Services as well as standardized application of the functional capacity evaluation (FCE). METHODS: This prospective randomized controlled trial is intended to evaluate the effects of the intervention programme on return to work. 150 patients who received the job-related programme (the intervention group) were compared to 150 patients who received the usual rehabilitation interventions (the control group). The study includes cardiac patients insured under the workers' pension insurance scheme and not older than age 56. Before coming to the clinic they had been unable to work, and problems with their returning to work were anticipated. Exclusion criteria were heart surgery less than three months ago, a cardiac capacity below 75 Watt, and reduced left-ventricular function. Follow-up data collection was performed 12 months after rehabilitation using a mail questionnaire. RESULTS: At the beginning of the rehabilitation programme, comparison of the groups showed no significant differences in biological, psychological and social variables. At 12-months follow-up, the data of 212 participants (70.6% of the participants) were available. Up to this time, 79.1% of the patients from the intervention group had returned to work, whereas in the control group only 62.9% had returned to work (chi(2) test, p<0.05). CONCLUSION: The results of the 12-months follow-up underline the positive effects of a job-oriented rehabilitation programme for patients' return to work.     

Accelerating the return to work (RTW) chances of coronary heart disease (CHD) patients: part 1--development and validation of a training programme

PURPOSE: Conventional phase II cardiac rehabilitation (CR) programmes have not resulted in an improvement in returning coronary heart disease (CHD) patients to work in over 35 years. This 4 year field-initiated research, sponsored by the National Institute on Disability and Rehabilitation Research, compares conventional CR programmes with a low-intensity CR programme that simulates elements of work (job-simulated CR programme) in terms of return to work (RTW) and physiological conditioning. The effect of training on physical capabilities of patients participating in the job-simulated CR programme was also of equal interest. METHOD: Thirty patients (15 bypass and 15 angioplasty; 15 males and 15 females) participated in a conventional CR programme (control group). The job-simulated CR programme included 15 male and 2 female bypass and angioplasty patients (experimental group). Patients in the control group underwent regular aerobic exercise training (treadmill and bicycle). Experimental group patients participated in a series of low-intensity exercises such as progressive time exercises, flexibility exercises, and dexterity exercises. RESULTS: All patients participating in the low-intensity job-simulated CR programme returned to the same job they held at the onset of myocardial infarction (MI). In contrast, only 60% of the control group patients returned to work; at least one-third of these did not go back to the same job they held at the onset of M1. Patients in both groups achieved the same level of physiological conditioning. The physical functional capabilities of the experimental group patients improved significantly throughout training. CONCLUSION: The results of this field-study lead to the conclusion that a low-intensity phase II cardiac rehabilitation programme that simulates elements of work may be far superior to conventional endurance exercise-based cardiac rehabilitation programmes in terms of returning patients to work. Such a programme also strengthens patients, improving their physical capabilities, without compromising their physiological conditioning.     

Accelerating the return to work (RTW) chances of coronary heart disease (CHD) patients: part 1 - development and validation of a training programme

Purpose : Conventional phase II cardiac rehabilitation (CR) programmes have not resulted in an improvement in returning coronary heart disease (CHD) patients to work in over 35 years. This 4 year field-initiated research, sponsored by the National Institute on Disability and Rehabilitation Research, compares conventional CR programmes with a low-intensity CR programme that simulates elements of work (job-simulated CR programme) in terms of return to work (RTW) and physiological conditioning. The effect of training on physical capabilities of patients participating in the job-simulated CR programme was also of equal interest. Method : Thirty patients (15 bypass and 15 angioplasty; 15 males and 15 females) participated in a conventional CR programme (control group). The job-simulated CR programme included 15 male and 2 female bypass and angioplasty patients (experimental group). Patients in the control group underwent regular aerobic exercise training (treadmill and bicycle). Experimental group patients participated in a series of low-intensity exercises such as progressive time exercises, flexibility exercises, and dexterity exercises. Results : All patients participating in the low-intensity job-simulated CR programme returned to the same job they held at the onset of myocardial infarction (MI). In contrast, only 60% of the control group patients returned to work; at least one-third of these did not go back to the same job they held at the onset of MI. Patients in both groups achieved the same level of physiological conditioning. The physical functional capabilities of the experimental group patients improved significantly throughout training. Conclusion : The results of this field-study lead to the conclusion that a low-intensity phase II cardiac rehabilitation programme that simulates elements of work may be far superior to conventional endurance exercise-based cardiac rehabilitation programmes in terms of returning patients to work. Such a programme also strengthens patients, improving their physical capabilities, without compromising their physiological conditioning.     

Accelerating the return to work (RTW) chances of coronary heart disease (CHD) patients: part 1 - development and validation of a training programme

Purpose: Conventional phase II cardiac rehabilitation (CR) programmes have not resulted in an improvement in returning coronary heart disease (CHD) patients to work in over 35 years. This 4 year field-initiated research, sponsored by the National Institute on Disability and Rehabilitation Research, compares conventional CR programmes with a low-intensity CR programme that simulates elements of work (job-simulated CR programme) in terms of return to work (RTW) and physiological conditioning. The effect of training on physical capabilities of patients participating in the job-simulated CR programme was also of equal interest. Method: Thirty patients (15 bypass and 15 angioplasty; 15 males and 15 females) participated in a conventional CR programme (control group). The job-simulated CR programme included 15 male and 2 female bypass and angioplasty patients (experimental group). Patients in the control group underwent regular aerobic exercise training (treadmill and bicycle). Experimental group patients participated in a series of low-intensity exercises such as progressive time exercises, flexibility exercises, and dexterity exercises. Results: All patients participating in the low-intensity job-simulated CR programme returned to the same job they held at the onset of myocardial infarction (MI). In contrast, only 60% of the control group patients returned to work; at least one-third of these did not go back to the same job they held at the onset of MI. Patients in both groups achieved the same level of physiological conditioning. The physical functional capabilities of the experimental group patients improved significantly throughout training. Conclusion: The results of this field-study lead to the conclusion that a low-intensity phase II cardiac rehabilitation programme that simulates elements of work may be far superior to conventional endurance exercise-based cardiac rehabilitation programmes in terms of returning patients to work. Such a programme also strengthens patients, improving their physical capabilities, without compromising their physiological conditioning.     

Psychological morbidity after myocardial infarction in an area of deprivation in the UK: evaluation of a self-help package.

BACKGROUND: Psychological morbidity after an acute myocardial infarction (AMI) is known to be common, but can be addressed by appropriate rehabilitation. The area in which this research was conducted experiences high rates of deprivation and of coronary heart disease and limited access to hospital-based rehabilitation. Responding to concern about psychological needs of AMI patients, a self-help package was introduced and evaluated alongside standard hospital-based cardiac rehabilitation. AIMS: To evaluate the impact of a home-based self-help package (the Heart Manual), alongside existing cardiac rehabilitation provision, on psychological morbidity and health status after AMI. A secondary aim was to assess the suitability of the Heart Manual for older patients aged over 80 years. METHODS: A controlled observational study, comparing two cohorts of patients discharged from hospital after AMI. The intervention group was given the self-help package in addition to standard care. The control group received standard care alone. Outcome measures used were the Hospital Anxiety and Depression Scale and the EuroQol. RESULTS: The intervention group showed significant improvement in anxiety and depression scores after 3 months and nonsignificant improvement in general health status. Patients who attended hospital-based rehabilitation classes, and those aged over 80 years, also benefited from the intervention. CONCLUSION: A home-based self-help rehabilitation package is an effective tool alongside hospital-based rehabilitation classes and can be given to all age groups.     

Effects of Sun-style Tai Chi exercise on physical fitness and fall prevention in fall-prone older adults

AIM: This paper reports a study to determine changes in the physical fitness (knee and ankle muscle strength, balance, flexibility, and mobility), fall avoidance efficacy, and fall episodes of institutionalized older adults after participating in a 12-week Sun-style Tai Chi exercise programme. BACKGROUND: Fall prevention has a high priority in health promotion for older people because a fall is associated with serious morbidity in this population. Regular exercise is effective in fall prevention for older adults because of improvements in strength and balance. Tai Chi exercise is considered to offer great potential for health promotion and rehabilitation, particularly in the maintenance of good mental and physical condition in older people. METHODS: A quasi-experimental design with a non-equivalent control group was used. Data were collected from September 2001 to January 2002. A total of 68 fall-prone older adults with a mean age of 77.8 years participated in the study, and 29 people in the Tai Chi group and 30 controls completed the post-test measures. The Tai Chi exercise programme was provided three times a week for 12 weeks in the experimental group. Data were analysed for group differences using t-tests. RESULTS: At post-test, the experimental group showed significantly improved muscle strength in knee and ankle flexors (P < 0.001) and extensors (P < 0.01), and improved flexibility (P < 0.01) and mobility (P < 0.001) compared with the control group. There was no significant group difference in fall episodes, but the relative risk ratio for the Tai Chi exercise group compared with the control group was 0.62. The experimental group reported significantly more confidence in fall avoidance than did the control group. CONCLUSION: The findings reveal that Tai Chi exercise programmes can safely improve physical strength and reduce fall risk for fall-prone older adults in residential care facilities.     

Geriatric rehabilitation on an acute-care medical unit

This study examined a geriatric rehabilitation pilot project on an acute-care medical unit. Over a 6-week period, using a 35-item geriatric rating scale and a mental assessment tool, changes in behaviours of 23 patients admitted to the geriatric rehabilitation module were compared to changes in behaviours of 10 elderly patients on a regular medical unit. The patients' demographic characteristics, their nursing and medical diagnoses, and discharge patterns were reviewed. Significant changes in behaviours of patients on the rehabilitation model included: increased ability to care for themselves, to maintain balance, and to communicate with others; decreased restlessness at night; decreased confusion; decreased incidence of incontinence; and improved social skills. The paper describes the geriatric rehabilitation programme and discusses implications for nursing of elderly patients in acute-care hospitals.     

Gender-related differences in clinical characteristics and physiological and psychosocial outcomes of Japanese patients at entry into phase II cardiac rehabilitation.

OBJECTIVE: To examine gender differences in clinical characteristics and physiological and psychosocial outcomes at entry into phase II cardiac rehabilitation. DESIGN: Cross-sectional study. SUBJECTS: The study comprised 442 consecutive patients with cardiac diseases assessed at entry into a phase II cardiac rehabilitation programme. METHODS: Clinical characteristics of the patients, such as age, education, marital status, employment and body mass index, were obtained from hospital records. Oxygen uptake, handgrip and knee extensor muscle strength were measured to assess physiological outcomes. Self-efficacy for physical activity, hospital anxiety depression scale and health-related quality of life assessed by Short Form-36 were evaluated to assess psychosocial outcomes. RESULTS: The number of married women and their levels of education, employment and body mass index were significantly lower, and their ages higher, than those of the men. Measures of physiological outcome in women were significantly lower than those in men. Measures of self-efficacy for physical activity and Short Form-36 physical and emotional subscale scores were lower and anxiety levels higher in women than in men. CONCLUSION: Cardiac rehabilitation programmes exclusively for women focusing on physiological outcomes, group counselling, and training to enhance physical and emotional domains may encourage increased participation by women in cardiac rehabilitation.