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Sarcoma or Phaeochromocytoma? Lessons from multi-disciplinary team working  [cached]
Paul Grant,Omar Mustafa,Val Lewington,John Quin
Endocrinology Studies , 2011, DOI: 10.4081/es.2011.e10
Abstract: An issue in the practice of oncology is the patient with a rare malignancy, where the challenge to the clinician is to rapidly understand the diagnosis and prioritise the best management approach. We present the case of a patient who was initially thought to have a malignant sarcoma and was eventually found to have an unusual, aggressive neuroendocrine tumour. This case stresses the importance of multi-disciplinary team (MDT) working and good communication and raises the pertinent issue of risk analysis in such settings. The case has greater relevance as it has led to a re-evaluation of how such cases are handled and heralded the introduction of a system of internal peer review.
Outcome Scales in Stroke Rehabilitation
Elif Aksakall?,Yasemin Turan,?mer Faruk ?endur
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: Stroke is known as the most common neurological disorder requiring rehabilitation. It is essential to assess the efficiency of rehabilitation for good practice. Studies on stroke rehabilitation led to the development of outcome measures, which can provide better assessment of stroke. In this review, functional and quality of life scales, commonly used and familiar to clinicians, are presented with their advantages and limitations.Turk J Phys Med Rehab 2009;55:168-72.
Interesting case of ovarian sarcoidosis: The value of multi disciplinary team working
Rekha Wuntakal, Rasiah Bharathan, Andrea Rockall, Arjun Jeyarajah
World Journal of Surgical Oncology , 2007, DOI: 10.1186/1477-7819-5-38
Abstract: The case presented here represents ovarian manifestation of sarcoidosis. At the point of referral to our hospital, based on computerised tomography (CT) ovarian carcinoma was a differential diagnosis. Further magnetic resonance imaging along with CT guided biopsy aided by laboratory study supported a diagnosis of sarcoidosis. Patient responded to medical management by a multidisciplinary team.The case shows the importance of FNAC and biopsy in case or ovarian masses and multi disciplinary team approach to management.Sarcoidosis of the genital tract is a rare condition. Ovarian manifestation of this disease is rarer still. In previously reported cases of genital tract sarcoidosis, the diagnosis was made on surgical specimen. We report the first case of non-surgical management of ovarian sarcoidosis. The successful management of this patient is principally due to the expertise offered by the multi disciplinary team (MDT). Our report highlights the importance of managing complex cases within a MDT environment.A 40-year-old para four obese Caucasian woman with two-year history of lower abdominal pain was referred from a peripheral hospital for the further management of bilateral adnexal masses. The computerised tomography (CT) scan of abdomen and pelvis revealed a complex cystic lesion of 7–8 cm in the right adnexum and bilateral ureteric obstruction. All baseline blood tests including haematology and tumour markers (CA 125 -26 IU/ml) were normal. The serum tests showed normal liver function and moderately impaired renal function (creatinine 10–15, urea > 200).She had a complex medical history including obstructive sleep apnoea, asthma, glaucoma, hypothyroidism, hypertensive cardiomyopathy and bipolar disorder; registered disabled. She also had a copper intra uterine contraceptive device in situ for the past three years. Given her body habitus (BMI 42), abdominal and pelvic examination was difficult and non-specific. The only finding of relevance was bilateral adnexal f
Functional Outcome of Inpatient Stroke Rehabilitation  [cached]
Ay?e Nur BARDAK,Sedef ERSOY,Zeynep AKCAN,Betül KAYA
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2008,
Abstract: Objective: The aim of this study was to evaluate the factors that affect functional outcomes in hemiplegic patients who presented at our hospital for rehabilitation.Materials and Methods: 150 patients who presented for therapy in January 2002 - November 2005 were included in the study. Demographic data, etiology, hemiplegic side and risk factors were recorded. The patients were evaluated before and after therapy with Brunnstrom scoring for motor evaluation, Rivermead Mobility Index for mobility, Barthel Index for functional improvement and Ashworth Scale for spasticity. Results: 86 women and 64 men were included in the study. Mean age was 62.36±11.72 years and mean rehabilitation time was 37.12 ±15 days. The mean Barthel Index Score was 50.56±21,37, 65.93±19.63 and mean Rivermead was 4.45±3.54, 7.06±3.71 before and after rehabilitation respectively. Significant improvements were noted in the Rivermead and Barthel Index at discharge when compared to values on admittance (p<0.05). It was determined that, although the rehabilitation results were not affected by sex, age or hemiplegic side, they were affected by their educational level. The improvement of patients having no spasticity was found to be better than those with spasticity. It was also found that progress in the Barthel Index scores of the patients who had joined a rehabilitation programme within 3 months after their stroke was considerably better. Conclusion: Rehabilitation of hemiplegic patients improves the functional state and mobility and provides motor improvement. Initiating rehabilitation at an early period after a stroke improves the rehabilitation results. Turk J Phys Med Rehab 2008;54:17-21.
Pain rehabilitation – outcome of an 8-week rehabilitation program  [cached]
Norrefalk J.R.,Borg K.
SHS Web of Conferences , 2012, DOI: 10.1051/shsconf/20120200007
Abstract: The prevalence of persistent pain has been estimated to be around 20-50% in a normal population. Musculoskeletal related pain is the most common form of persistent pain. In patients with persistent pain there are alterations in the peripheral as well as the central nervous system and patients develop a dysfunctional behaviour which, in many cases, leads to severe suffering for the patient. In the European countries an increasing problem has emerged consisting of more people on long-term sick-leave, increased number of early retirements and high social costs. After an 8-week structured multiprofessional rehabilitation programme at the Karolinska Institute in Stockholm, Sweden 63% of patients with long-standing non-malignant pain returned to work and half of the patients were still at work at a 6-year follow-up. Half of the patients reported pain reduction and almost half of the patients had reduced their consumption of analgesics. The rehabilitation program was estimated as economically beneficial on a society level. It is concluded that pain rehabilitation should have a multiprofessional approach. Pain rehabilitation programs are beneficial for the possibility for the patient to return to work pain and leads to pain reduction in the long run. Furthermore, they are beneficial from a socio-economical aspect.
Open Access Publishing: The Future of Rehabilitation Research
Devdeep Ahuja
International Journal of Physiotherapy and Rehabilitation , 2010,
Abstract: Rehabilitation professions have evolved over the past century from being an adjunct to the medical services to an essential part of the multi disciplinary team. In the recent years, the Open Access movement has gained momentum through various publishers like Pubmed Central and Biomed Central, who provide immediate free open access to the users. This article looks into the Open Access Publication in Physiotherapy, the benefits and challenges it faces for its growth into the preferential publishing model.
Rehabilitation outcome after traumatic brain injury
Irdesel,J.; Aydiner,S.B.; Akgoz,S.;
Neurocirugía , 2007, DOI: 10.4321/S1130-14732007000100001
Abstract: rehabilitation goals after traumatic brain injury are improving function, increasing the level of independence as high as possible, preventing complications and providing an acceptable environment to the patient. several complications can be encountered during the rehabilitation period which lead to physical, cognitive and neurobehavioral impairments that cause major delay in functional improvement. this prospective study was designed in order to investigate the complications and their relations with functional recovery in patients that were included in the acute phase of a rehabilitation program. thirty traumatic brain injured patients admitted to the intensive care units of uludag university school of medicine were included in the study. rehabilitation program consisted in appropriate positioning, range of motion exercises, postural drainage and respiratory exercises. complications that were encountered during intensive care rehabilitation program were recorded. all patients were evaluated by functional independence measure, disability rating scale and ranchos los amigos levels of cognitive function scale at admission and discharge. improvement was observed in patients in terms of functional outcome and disability levels. pneumonia, athelectasis, anemia and meningitis were the most frequent complications. deterioration in functional out-come and disability levels was noted as the number of these complications increased. in conclusion, rehabilitation has an important role in the management of traumatic brain injured patients. reduction of frequency of complications and improvement in functional outcome and disability levels can be achieved through rehabilitation programs. long-term controlled studies with large number of patients are needed in order to obtain accurate data on factors associated with rehabilitation outcomes
Inpatient rehabilitation outcome: a matter of diagnosis?
Bejor M,Ramella FC,Dalla Toffola E,Comelli M
Neuropsychiatric Disease and Treatment , 2013,
Abstract: Maurizio Bejor,1 Francesca Chiara Ramella,1 Elena Dalla Toffola,1 Mario Comelli,2 Matteo Chiappedi31University of Pavia, Department of Surgical, Resuscitative, Rehabilitative and Transplant Sciences, Pavia, Italy; 2University of Pavia, Department of Brain Sciences, Medical Statistics Section, Pavia, Italy; 3Don Carlo Gnocchi ONLUS Foundation, Milan, ItalyBackground: Patients with comorbidities are becoming more and more common in Italian rehabilitative wards. These comorbidities are considered a major problem for inpatient rehabilitation, due to the fact that they cause longer lengths of stay, higher costs, and lower functional results.Methods: To investigate the possible relationships between comorbidity, functional impairment, age, and type of discharge in patients hospitalized in postacute rehabilitation facilities, we planned an observational study. A total of 178 consecutive inpatients (average age: 78 years [range: 39–99]) from postacute rehabilitation facilities were recruited. Primary diagnosis, comorbidity rating (Cumulative Illness Rating Scale – Geriatric version, CIRS-G) and functional impairment score (Functional Independence Measure, FIM ) were evaluated at admission. The FIM rating was also assessed at hospital discharge.Results: A total of 178 of the 199 enrolled patients completed the rehabilitation treatment (89.4%). The average length of stay was 46 ± 24 days. CIRS-G showed an average comorbidity score for each patient of 4.45 ± 1.69. The average FIM rating was 79 ± 24.88 at admission, and 91.9 ± 25.7 at discharge. Diagnosis at admission (grouped according to the International Classification of Diseases 9-CM) seemed to correlate with functional results, since lower rehabilitative efficiency was obtained for patients who had a history of stroke.Conclusion: The number and type of comorbidities (CIRS-G) in rehabilitation inpatients do not seem to affect functional outcomes of treatment. The determining factor for a lower level of functional recovery seems to be the diagnosis at admission.Keywords: diagnosis, rehabilitation, inpatients, outcome
Inpatient rehabilitation outcome: a matter of diagnosis?
Bejor M, Ramella FC, Dalla Toffola E, Comelli M, Chiappedi M
Neuropsychiatric Disease and Treatment , 2013, DOI: http://dx.doi.org/10.2147/NDT.S39922
Abstract: patient rehabilitation outcome: a matter of diagnosis? Original Research (480) Total Article Views Authors: Bejor M, Ramella FC, Dalla Toffola E, Comelli M, Chiappedi M Published Date February 2013 Volume 2013:9 Pages 253 - 257 DOI: http://dx.doi.org/10.2147/NDT.S39922 Received: 04 November 2012 Accepted: 30 November 2012 Published: 18 February 2013 Maurizio Bejor,1 Francesca Chiara Ramella,1 Elena Dalla Toffola,1 Mario Comelli,2 Matteo Chiappedi3 1University of Pavia, Department of Surgical, Resuscitative, Rehabilitative and Transplant Sciences, Pavia, Italy; 2University of Pavia, Department of Brain Sciences, Medical Statistics Section, Pavia, Italy; 3Don Carlo Gnocchi ONLUS Foundation, Milan, Italy Background: Patients with comorbidities are becoming more and more common in Italian rehabilitative wards. These comorbidities are considered a major problem for inpatient rehabilitation, due to the fact that they cause longer lengths of stay, higher costs, and lower functional results. Methods: To investigate the possible relationships between comorbidity, functional impairment, age, and type of discharge in patients hospitalized in postacute rehabilitation facilities, we planned an observational study. A total of 178 consecutive inpatients (average age: 78 years [range: 39–99]) from postacute rehabilitation facilities were recruited. Primary diagnosis, comorbidity rating (Cumulative Illness Rating Scale – Geriatric version, CIRS-G) and functional impairment score (Functional Independence Measure, FIM ) were evaluated at admission. The FIM rating was also assessed at hospital discharge. Results: A total of 178 of the 199 enrolled patients completed the rehabilitation treatment (89.4%). The average length of stay was 46 ± 24 days. CIRS-G showed an average comorbidity score for each patient of 4.45 ± 1.69. The average FIM rating was 79 ± 24.88 at admission, and 91.9 ± 25.7 at discharge. Diagnosis at admission (grouped according to the International Classification of Diseases 9-CM) seemed to correlate with functional results, since lower rehabilitative efficiency was obtained for patients who had a history of stroke. Conclusion: The number and type of comorbidities (CIRS-G) in rehabilitation inpatients do not seem to affect functional outcomes of treatment. The determining factor for a lower level of functional recovery seems to be the diagnosis at admission.
Rollator use and functional outcome of geriatric rehabilitation  [PDF]
Lutz Vogt, PhD,Katrin Lucki, MA,Matthias Bach, MD,Winfried Banzer, MD, PhD
Journal of Rehabilitation Research and Development , 2010,
Abstract: In a quasi-experimental pre- and postdesign, we examined the effect of rollator use on functional rehabilitation outcome in geriatric patients. From a sample of 458 geriatric inpatients, we matched 30 subjects who were not using assistive devices in their everyday lives but received a wheeled walker at the time of hospital admission (first-time user group) according to their admission scores on three motor performance tests (Timed Up-and-Go, Five-Times-Sit-to-Stand, and Performance-Oriented Mobility Assessment-Balance) with 30 patients who were actively using rollators as their primary walking aid for at least 3 months (long-term user group) and 30 control subjects without walking-aid assistance. Measurements were repeated after the inpatient rehabilitation regimen. The Kruskal-Wallis test did not reveal significant group differences in rehabilitation progress. Controls and device users, regardless of walking-aid experience, demonstrated nearly comparable mobility, strength, and balance improvements. More than half of each cohort (controls, n = 22; first-time, n = 17; long-term, n = 18) achieved functional gains in all three motor tests. The study showed that rollator assistance does not interfere with rehabilitation outcome and, to some extent, legitimates the prescription of assistive devices to improve confidence and restore or maintain motor ability at the highest possible level.
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