The Experience, Prerequisites, and the Barriers in Organizing a Specialized Rehabilitation Program for Patients with Pulmonary Hypertension

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Eglė Palevičiūtė ◽  
Lina Gumbienė ◽  
Elena Jurevičienė ◽  
Toma Šimbelytė ◽  
Ieva Laucevičienė ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Scientific Evidence ◽  
Poor Quality ◽  
Rehabilitation Program ◽  
Eligibility Criteria ◽  
Early Effect ◽  
Team Members ◽  
First Results ◽  
Preparation Phase ◽  
Rehabilitation Facilities

<b><i>Background:</i></b> Pulmonary hypertension (PH) is a severe progressive disease, associated with reduced exercise capacity and poor quality of life. Although scientific evidence supports the incorporation of specialized training in the treatment of PH, it is only available in a few countries. <b><i>Objectives and Methods:</i></b> This article aims to share the experience of implementing a PH rehabilitation program, to summarize the barriers and prerequisites for launching this service, and to assess its early effect. We retrospectively analyzed our pathway in organizing this program, by singling out essential steps. <b><i>Results:</i></b> The preparation phase took about 14 months. Establishing and running of a PH rehabilitation program required dedicated rehabilitation specialists to join the multidisciplinary PH expert team. Team members needed to gain special knowledge on exercise training in severely compromised patients; thus, supervision and education by experienced consultants was crucial. The main eligibility criteria for patients were stable status, optimal medical treatment, and motivation to undergo the training. The first results evaluating the effect of a specialized PH training program in 9 patients are promising. Seven of them improved their functional capacity over the period of 15 weeks. <b><i>Conclusions:</i></b> Despite a number of challenges and barriers, the implementation of a specialized rehabilitation program should be encouraged in a few dedicated PH expert centers per country, who are capable to fulfill all prerequisites and organizational aspects. Local PH experts, supervision by an experienced center, in-patient rehabilitation facilities, dedicated personnel, equipment, and patient motivation are essential.

The Lower Limb Amputee Measurement Scale: Reliability and predictive validity

2007 ◽  
Vol 31 (3) ◽  
pp. 300-312 ◽  
Author(s):  
Oren Cheifetz ◽  
Mark Bayley ◽  
Sharon Grad ◽  
Debbie Lambert ◽  
Cass Watson ◽  
...  
Keyword(s):  
Predictive Validity ◽  
Lower Limb ◽  
Assessment Tool ◽  
Pearson Correlation ◽  
Rehabilitation Program ◽  
Measurement Scale ◽  
Initial Assessment ◽  
Team Members ◽  
Scale Reliability ◽  
Lower Limb Amputee

This study assesses the reliability and predictive validity of the Lower Limb Extremity Amputee Measurement Scale (LLAMS), which is an assessment tool designed to predict the length of stay (LOS) of patients with lower limb amputations in a rehabilitation program. In order to evaluate inter-rater reliability a prospective evaluation was completed by five independent evaluators ( n = 10). Predictive validity was evaluated retrospectively by comparing the LLAMS predicted LOS to actual LOS ( n = 147). The ability of the amputee team members to administer the LLAMS to patients was very high (ICC [2,1] = 0.98, CI 95% = 0.96 – 0.99, F[9, 36] = 78.71, p < 0.05). In addition, a moderate positive correlation was found between the LLAMS predicted LOS and the actual LOS (Pearson Correlation Coefficient, r = 0.465, p < 0.01), and the LLAMS was able to identify those patients who required short versus long rehabilitation stays. The incorporation of the LLAMS into the physiatrist's initial assessment of patients in the amputee clinic has enhanced the ability to manage better the LOS and the time patients wait to enter the rehabilitation program.

scholarly journals Scoping review of mental health in prisons through the COVID-19 pandemic

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046547
Author(s):  
Luke Johnson ◽  
Kerry Gutridge ◽  
Julie Parkes ◽  
Anjana Roy ◽  
Emma Plugge
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Grey Literature ◽  
Well Being ◽  
Health Impact ◽  
Poor Quality ◽  
Eligibility Criteria ◽  
Prison Staff ◽  
The Impact

ObjectiveTo examine the extent, nature and quality of literature on the impact of the COVID-19 pandemic on the mental health of imprisoned people and prison staff.DesignScoping review.Data sourcesPubMed, Embase, CINAHL, Global Health, Cochrane, PsycINFO, PsychExtra, Web of Science and Scopus were searched for any paper from 2019 onwards that focused on the mental health impact of COVID-19 on imprisoned people and prison staff. A grey literature search focused on international and government sources and professional bodies representing healthcare, public health and prison staff was also performed. We also performed hand searching of the reference lists of included studies.Eligibility criteria for selection of studiesAll papers, regardless of study design, were included if they examined the mental health of imprisoned people or prison staff specifically during the COVID-19 pandemic. Imprisoned people could be of any age and from any countries. All languages were included. Two independent reviewers quality assessed appropriate papers.ResultsOf 647 articles found, 83 were eligible for inclusion, the majority (58%) of which were opinion pieces. The articles focused on the challenges to prisoner mental health. Fear of COVID-19, the impact of isolation, discontinuation of prison visits and reduced mental health services were all likely to have an adverse effect on the mental well-being of imprisoned people. The limited research and poor quality of articles included mean that the findings are not conclusive. However, they suggest a significant adverse impact on the mental health and well-being of those who live and work in prisons.ConclusionsIt is key to address the mental health impacts of the pandemic on people who live and work in prisons. These findings are discussed in terms of implications for getting the balance between infection control imperatives and the fundamental human rights of prison populations.

A Quality Assessment of Online Patient Information Regarding Rhinoplasty

2021 ◽  
Author(s):  
Eamon Shamil ◽  
Gabriela Di Scenza ◽  
Shahi Abdul Ghani ◽  
Ka Siu Fan ◽  
Suthaharan Ragulan ◽  
...  
Keyword(s):  
Patient Information ◽  
Poor Quality ◽  
Complication Rates ◽  
Eligibility Criteria ◽  
Risks And Benefits ◽  
Search Terms ◽  
Outcome Management ◽  
Balanced Information ◽  
Unrealistic Expectations

AbstractThere is a large demand for online patient information for patients considering rhinoplasty. While there are many resources available, the quality and content of the information provided are unknown. This study aimed to assess the quality of the most popular information available online, using the “Ensuring Quality Information for Patients” (EQIP) tool to evaluate the content, structure, and readability of patient information on websites. Search terms including nose operation, nose job, nose reshaping, nose tip surgery, rhinoplasty, septorhinoplasty, were identified using Google AdWords and Trends. Unique links from the first 10 pages for each term were identified and evaluated with websites written in English and for general non-medical public use were included. 295 websites met the eligibility criteria with a median overall EQIP score of 17. Only 33% contained balanced information on the risks and benefits. Bleeding and infection risk was only mentioned in 29% and 27% of websites, respectively. Two percent described complication rates of the procedures and only 20% of articles explained further surgery may be required to achieve patient cosmetic or functional satisfaction. Information regarding rhinoplasty available online is currently of poor quality. The lack of effective risk counselling, possible outcome management, and complications may likely lead to unrealistic expectations of rhinoplasty. It is crucial the risks of surgery are communicated to the patient to ensure they can make an informed decision. Improved education through online resources would likely help to promote more realistic patient expectations.

Innovative Technique for the Closure of Rectovaginal Fistula Using Amplatzer™ Septal Occluder

2021 ◽  
Vol 10 (29) ◽  
pp. 2225-2227
Author(s):  
Omer Alabaz ◽  
Ugur Topal
Keyword(s):  
Rectovaginal Fistula ◽  
Vascular Tissue ◽  
Surgical Flaps ◽  
Severe Infection ◽  
Poor Quality ◽  
Pelvic Cavity ◽  
First Results ◽  
Standardized Treatment ◽  
Pass Through ◽  
Tissue Flaps

Rectovaginal fistulas (RVF) result from an abnormal epithelial connection between the vagina and the rectum, allowing the intestinal contents to pass through the vagina.1 Patients may clinically present with vaginal faeces or gas discharge in addition to inflammation in the pelvic cavity, which may lead to severe infection and poor quality of life.2 RVF is seen in women who previously received treatment for a malignant disease in the pelvic region. The malignancies in the pelvic area are often treated with radiotherapy. This treatment results in tissue damage and poor healing.3 Management of postoperative RVF is difficult and the results are often unsatisfactory. Currently there is no widely accepted and standardized treatment for RVF.3, 4 In the treatment of RVF, various surgical flaps (endorectal or vaginal), vascular tissue flaps (Martius, gracilis), grafts or biomaterials have been used.3,5,6 This case shows the first results using the Amplatzer™ Septal Occluder for the closure of rectovaginal fistula.

First Report on the Publication and Conservation of the Tomb of Ramesses III in the Valley of the Kings (KV 11)

2018 ◽  
Vol 104 (1) ◽  
pp. 59-69
Author(s):  
Anke Weber
Keyword(s):  
Ancient Egypt ◽  
Historical Background ◽  
Annual Reports ◽  
Team Members ◽  
First Report ◽  
The Public ◽  
Conservation Project ◽  
First Results ◽  
Long Time ◽  
Glass Panels

The tomb of Ramesses III (KV 11) in the Valley of the Kings is one of the archaeological sites of ancient Egypt that has received very little attention from the scientific community. The tomb was open to the public for a long time and is in danger of quick deterioration. The site was closed from August 2016 until October 2017 for the installation of new walkways, glass panels, and an improved lighting system. The Ramesses III (KV 11) Publication and Conservation Project now aims to record, document, and preserve the entire tomb. This article is a first report on the planned publication and conservation of the tomb of Ramesses III (KV 11) in the Valley of the Kings. Like so many other tombs in the wadi, it presents the astonishing case of a tomb that has been known for a long time but was never thoroughly studied. In the following, we present the research aims of the newly formed Ramesses III (KV 11) Publication and Conservation Project1 as well as the preparatory work that has been undertaken by our team members. All observations and notes were made over the last six years during short campaigns, partly within the framework of a previous research project,2 which constitutes the basis of preliminary work in KV 11. The article focuses on the historical background of the tomb, its research history, including former investigators and concessions, supposed causes of destruction, suggestions for preservation, and procedures for research and documentation. We present the main problems we have to deal with at the outset of the project and describe the methods we propose to adopt. Further annual reports on the progress and first results of our work in order to preserve this important site of Egypt’s cultural heritage will follow in due course.

scholarly journals The revised definition of pulmonary hypertension: exploring the impact on patient management

2019 ◽  
Vol 21 (Supplement_K) ◽  
pp. K4-K8 ◽  
Author(s):  
Gérald Simonneau ◽  
Marius M Hoeper
Keyword(s):  
Pulmonary Hypertension ◽  
Scientific Evidence ◽  
Management Strategies ◽  
Pulmonary Vascular Disease ◽  
Close Monitoring ◽  
Mean Pulmonary Arterial Pressure ◽  
Increased Risk ◽  
Patient Groups ◽  
Definition Of ◽  
The Impact

Abstract At the 6th World Symposium on Pulmonary Hypertension (PH), it was proposed that the mean pulmonary arterial pressure (mPAP) threshold used to define PH should be lowered from ≥25 mmHg to &gt;20 mmHg. The rationale for this change is that the ≥25 mmHg threshold is arbitrary, whereas the revised threshold is based on scientific evidence. For the definition of all forms of pre-capillary PH, the inclusion of a pulmonary vascular resistance (PVR) ≥3 Wood Units was also proposed, placing greater emphasis on an elevated PVR to identify pulmonary vascular disease. Here, we discuss the possible impact of the revised definition of PH on future clinical management. This change may facilitate earlier PH detection, particularly in at-risk patient groups that are already undergoing screening programmes, e.g. those with systemic sclerosis or mutations associated with PH. As an mPAP above the upper limit of normal (&gt;20 mmHg) but &lt;25 mmHg is associated with increased risk of morbidity and mortality compared with a normal mPAP, early identification of patients in this group is important to enable close monitoring and timely treatment initiation once clinically indicated. Treatments currently approved for PH are not necessarily suitable for patients with an mPAP 21–24 mmHg, as the management of this group has not been widely examined. The revised definition may facilitate inclusion of these patients in prospective trials, allowing the evaluation of appropriate management strategies.

Cologne High-Dose Sequential Chemotherapy in Relapsed and Refractory Hodgkin Lymphoma - Results of a Large Multicenter Study of the German Hodgkin Lymphoma Study Group (GHSG).

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 309-309 ◽  
Author(s):  
Andreas Josting ◽  
Christian Rudolph ◽  
Markus Mapara ◽  
Jan-Peter Glossmann ◽  
Markus Sieber ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hodgkin Lymphoma ◽  
Late Relapse ◽  
High Dose ◽  
Sequential Chemotherapy ◽  
Eligibility Criteria ◽  
First Results ◽  
First Remission ◽  
Multiple Relapse ◽  
Lymphoma Study Group

Abstract Purpose: Combination chemotherapy can cure patients (pts) with Hodgkin lymphoma (HD), but those with treatment failure or relapse still have a poor prognosis. We thus, designed a dose- and time-intensified high-dose sequential chemotherapy regimen with a final myeloablative course. Patients and Methods: Eligibility criteria included age 18–65 years, histologically proven primary progressive (PD) or relapsed HD. Treatment consists of two cycles DHAP (dexamethasone 40mg d1-4, high-dose cytarabin 2g/m2 12q d2, cisplatinum 100mg/m2 d1); pts with partial (PR) or complete remission (CR) received cyclophosphamide 4g/m2, followed by peripheral blood stem cell (PBSC) harvest; methotrexate 8g/m2 plus vincristine 1,4mg/m2; and etoposide 2g/m2. The final myeloblative course was BEAM followed by PBSCT. Results: 102 pts (median age 34 years, range 18–64) were enrolled. The response rate (RR) at the final evaluation (100 days posttransplantation) was 80% (72% CR, 8% PR). PBSC harvest was succesful in 96% of pts. Toxicity was tolerable. With a median follow-up of 30 months (range 3–61 months) freedom from second failure (FF2F) and overall survival (OS) were 59% and 78% for all patients, respectively. FF2F and OS for patients with early relapse were 62% and 81%, for late relapse 65% and 81%; for PD: 41% and 48% and for multiple relapse 39% and 48%, respectively. In multivariate analysis response after 2 cycles of DHAP (p &lt; 0.0001) and duration of first remission (PD and multiple relapse vs. early and late relapse; p = 0.0127) were prognostic factors for FF2F. Response after DHAP (p &lt; 0.0081), duration of first remission (p = 0.0017) and anemia (p = 0.019) were identified as prognostic factors for OS. Conclusion: We conclude that this regimen is feasible, tolerable and highly effective in poor risk patients with relapsed and refractory HD. Based on these results a prospective randomized european intergoup study was started comparing this intensified regimen with two courses of DHAP followed by BEAM (HD-R2 protocol). First results of the second interim analysis of this study will be presented.

scholarly journals Circulating Adipokine Levels in Nonobese Women With Polycystic Ovary Syndrome and in Nonobese Control Women: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Kainan Lin ◽  
Xiaoting Sun ◽  
Xiao Wang ◽  
Hanchu Wang ◽  
Xia Chen
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Web Of Science ◽  
Polycystic Ovary ◽  
Meta Analysis ◽  
Scientific Evidence ◽  
Healthy Controls ◽  
Ovary Syndrome ◽  
Eligibility Criteria ◽  
Standardized Mean Difference ◽  
Circulating Levels

Levels of circulating adipokines in nonobese polycystic ovary syndrome (PCOS) patients have been reported in many studies. However, the results are inconsistent. The aim of this meta-analysis is to assess whether the levels of circulating adipokines are changed in nonobese PCOS relative to nonobese healthy controls. To identify eligible studies, a literature research was performed in the PubMed, Embase, and Web of Science databases without restricting by region, journal, or language. A total of 81 studies met the eligibility criteria. The meta-analysis showed that the circulating level of adiponectin (standardized mean difference [SMD]: -0.95; 95% CI: -1.36 to -0.53) was significantly decreased in nonobese PCOS patients. In contrast, the circulating levels of chemerin (SMD: 1.13; 95% CI: 0.08 to 2.18), leptin (SMD: 0.47; 95% CI: 0.13 to 0.81), resistin (SMD: 0.45; 95% CI: 0.03 to 0.88), and visfatin (SMD: 1.38; 95% CI: 0.68 to 2.09) were significantly increased in nonobese PCOS patients. There were no significant changes in the circulating levels of apelin (SMD: 0.32; 95% CI: -1.34 to 1.99), irisin (SMD: 1.01; 95% CI: -0.68 to 2.70), omentin (SMD: -0.37; 95% CI: -1.05 to 0.31), or vaspin (SMD: 0.09; 95% CI: -0.14 to 0.32). Thus, scientific evidence suggests that the circulating adipokine levels are altered in nonobese PCOS patients compared to nonobese healthy controls. Therefore, independent of the degree of obesity, dysregulated circulating adipokine levels might play important roles in the occurrence and development of PCOS.

scholarly journals Is mindfulness research methodology improving over time? A systematic review

2018 ◽  
Author(s):  
Simon Goldberg ◽  
Raymond P. Tucker ◽  
Preston A. Greene ◽  
Tracy L. Simpson ◽  
David Kearney ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Scientific Evidence ◽  
Treatment Fidelity ◽  
The Body ◽  
Synthesis Methods ◽  
Eligibility Criteria ◽  
Clinical Disorder ◽  
Fidelity Assessment ◽  
Methodological Improvement

Background: Despite an exponential growth in research on mindfulness-based interventions, the body of scientific evidence supporting these treatments has been criticized for being of poor methodological quality. Objectives: The current systematic review examined the extent to which mindfulness research demonstrated increased rigor over the past 16 years regarding six methodological features that have been highlighted as areas for improvement. These feature included using active control conditions, larger sample sizes, longer follow-up assessment, treatment fidelity assessment, and reporting of instructor training and intent-to-treat (ITT) analyses. Data sources: We searched PubMed, PsychInfo, Scopus, and Web of Science in addition to a publically available repository of mindfulness studies. Study eligibility criteria: Randomized clinical trials of mindfulness-based interventions for samples with a clinical disorder or elevated symptoms of a clinical disorder listed on the American Psychological Association’s list of disorders with recognized evidence-based treatment. Study appraisal and synthesis methods: Independent raters screened 9,067 titles and abstracts, with 303 full text reviews. Of these, 171 were included, representing 142 non-overlapping samples. Results: Across the 142 studies published between 2000 and 2016, there was no evidence for increases in any study quality indicator, although changes were generally in the direction of improved quality. When restricting the sample to those conducted in Europe and North America (continents with the longest history of scientific research in this area), an increase in reporting of ITT analyses was found. When excluding an early, high-quality study, improvements were seen in sample size, treatment fidelity assessment, and reporting of ITT analyses. Conclusions and implications of key findings: Taken together, the findings suggest modest adoption of the recommendations for methodological improvement voiced repeatedly in the literature. Possible explanations for this and implications for interpreting this body of research and conducting future studies are discussed.

scholarly journals Evidências sobre o isolamento social em pacientes com exsudato em feridas neoplásicas: revisão integrativa

2019 ◽  
Vol 81 (19) ◽  
Author(s):  
Willian Alves dos Santos ◽  
Patricia dos Santos Claro Fuly ◽  
Mauro Leonardo Salvador Caldeira dos Santos ◽  
Marise Dutra Souto ◽  
Caroline Marques Reis ◽  
...  
Keyword(s):  
Social Isolation ◽  
Systematic Reviews ◽  
Medical Literature ◽  
Scientific Evidence ◽  
Psychosocial Aspects ◽  
Literature Analysis ◽  
Microsoft Excel ◽  
Eligibility Criteria ◽  
Cochrane Database ◽  
On Line

Objetiva-se identificar as evidências científicas sobre o isolamento social em pacientes com feridas neoplásicasexsudativas. Revisão integrativa realizada nas bases de dados da Biblioteca Virtual de Saúde (BVS) e PubMed: LiteraturaLatino Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem on-line(MEDLINE) e Cochrane Database of Systematic Reviews (COCHRANE) com a questão norteadora: quais são as evidênciascientíficas sobre o isolamento social em pacientes com feridas neoplásicas exsudativas? Utilizou-se estratégia PICOcom recorte temporal de 2002 a 2014, nos idiomas português, inglês e espanhol. As informações foram tabuladas emprograma Microsoft Excel® e processadas a partir da média aritmética descritiva simples, frequência absoluta e relativa.Identificaram-se 288 artigos em sua totalidade. Após aplicação dos critérios de elegibilidade, foram selecionadas 23evidências científicas avaliadas a partir da categoria: os principais aspectos psicossociais prejudicados pelo exsudatoem pacientes com feridas neoplásicas. Concluí-se que o exsudato é um dos sintomas que interfere negativamente nosaspectos psicossociais do paciente com feridas neoplásicas, causando alteração da imagem corporal, perda dos limitesfísicos, ansiedade e depressão, fatores que favorecem diretamente o isolamento social.Palavras-chave: Cuidados Paliativos; Enfermagem Oncológica; Ferimentos e Lesões; Exsudatos e Transudatos;Isolamento Social. ABSTRACTThe aim is to identify the scientific evidence on social isolation in patients with exudative neoplastic wounds.An integrative literature review conducted in the Virtual Health Library databases (VHS) and PubMed: LiteratureLatin American and Caribbean Health Sciences (LILACS), Medical Literature Analysis and Retrieval System online(MEDLINE) and Cochrane Database of Systematic Reviews (COCHRANE), with the guiding question: what are thescientific evidences about the social isolation in patients with exudative neoplastic wounds? We used a PICOstrategy with a temporal cut from 2002 to 2014, in Portuguese, English and Spanish languages. The informationwas tabulated in Microsoft Excel® program and processed from simple descriptive arithmetic mean, absoluteand relative frequency. It was identified 288 articles in their entirety. After applying the eligibility criteria, wasselected 23 scientific evidence evaluated from the category: the main psychosocial aspects impaired by exudatein patients with neoplastic wounds. It concludes that exudate is one of the symptoms that negatively interferesthe psychosocial aspects of the patient with neoplastic wounds, causing alterations in body image, loss of physicallimits, anxiety and depression, factors that directly favor social isolation.Keywords: Palliative Care; Oncology Nursing; Wounds and Injuries; Exudates and Transudates; Social Isolation.

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