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Patient Mobility (patient + mobility)
Selected AbstractsEuropean Study on Orthopaedic Status of haemophilia patients with inhibitorsHAEMOPHILIA, Issue 5 2007M. MORFINI Summary., ,Development of inhibitors against factor VIII (FVIII) or factor IX (FIX) in haemophilia patients is one of the most serious complications of repeated exposure to replacement therapy and has major clinical and economic consequences. To evaluate the relationship between inhibitor status of haemophilia patients and their quality of life (QoL) and degree of arthropathy and to compare the orthopaedic status of patients with/without inhibitors. An observational, cross-sectional, case control study enrolling: group A (n = 38), males aged 14,35 years, with severe congenital haemophilia A or B who had inhibitors against FVIII/FIX >5 years; group B (n = 41), as group A, but aged 36,65 years and group C (n = 49), as group A, but without inhibitors. Socio-demographics: medical history, clinical characteristics and QoL were assessed. In groups A and B, 16% and 27% were hospitalized for orthopaedic procedures vs. 4% in group C. Patient mobility was also severely reduced in groups A and B, with 24% and 22% using wheelchairs vs. 4% in group C, and 50% and 51% needing a walking aid vs. 29% in group C. Significantly more joint pain was reported by patients in group A vs. those in group C; clinical/radiological orthopaedic scores were also worse in group A vs. group C. Significantly more joint abnormality was reported by patients in group A vs. group C. The burden of orthopaedic complications and the impact on QoL are more severe in haemophilia patients who have developed inhibitors than in those without inhibitors. [source] Comparison of dental licensure, specialization and continuing education in five countriesEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2002Titus Schleyer Dental practice and education are becoming more globalized. Greater practitioner and patient mobility, the free flow of information, increasingly global standards of care and new legal and economic frameworks (such as European Union [EU] legislation) are forcing a review of dental licensure, specialization and continuing education systems. The objective of this study was to compare these systems in Canada, France, Germany, the UK and the US. Representatives from the five countries completed a 29-item questionnaire, and the information was collated and summarized qualitatively. Statutory bodies are responsible for licensing and re-licensing in all countries. In the two North American countries, this responsibility rests with individual states, and in Europe, with the countries themselves, mainly governed by the legal framework of the EU. In some countries, re-licensure requires completion of continuing education credits. Approaches to dental specialization tend to differ widely with regard to definition of specialities, course and duration of training, training facilities, and accreditation of training programmes. In most countries, continuing education is provided by a number of different entities, such as universities, dental associations, companies, institutes and private individuals. Accreditation and recognition of continuing education is primarily process-driven, not outcome-orientated. Working towards a global infrastructure for dental licensing, specialization and continuing education depends on a thorough understanding of the international commonalities and differences identified in this article. [source] The geography of hospital admission in a national health service with patient choiceHEALTH ECONOMICS, Issue 9 2010Daniele Fabbri Abstract Each year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for ,trade' in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enroless for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool. Copyright © 2010 John Wiley & Sons, Ltd. [source] Dermatomyositis presenting as panniculitisINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2000Yen-Yu Chao MD A 44-year-old obese woman was transferred to our clinic with a diagnosis of panniculitis. Examination showed multiple, indurated, erythematous, painful nodules and plaques distributed on the shoulders, back, forechest, abdomen, buttock, and bilateral thighs. These skin lesions appeared 2 months previously, measured 5,8 cm, and were tender on palpation. No obvious inducing factor was traced. The lesions seemed unresponsive to treatment with nonsteroidal anti-inflammatory drugs (ibuprofen, 400 mg three times a day) as similar lesions appeared in subsequent visits. Progressive proximal muscle weakness was found 1 month later. She was then admitted via the emergency room because of extensive painful skin plaques and abdominal pain. Diffuse erythematous to violaceous swelling of the face, neck, and shoulder was noted at about the same time ( Fig. 1). A skin biopsy specimen from the nodular lesion showed poikilomatous epidermal changes ( Fig. 2), and marked mononuclear cell infiltration in the dermis and subcutaneous fat ( Fig. 3). Dermatomyositis was considered as the diffuse violaceous facial erythema could be a form of heliotrope eruption, but Gottron's papule was not found. At admission, serum creatinine phosphokinase (CPK) was mildly elevated (436 IU/L; normal range, 20,170 IU/L), but serum asparagine transaminase (AST) and lactate dehydrogenase (LDH) levels were within normal limits (36 IU/L; normal, 11,47 IU/L; and 108 IU/L; normal, 90,280 IU/L, respectively). Antinuclear antibody was 1 : 80 positive with an atypical speckled pattern. Muscle strength was weakest during the first 2 days, about grade 3 by the Medical Research Council (MRC) of Great Britain scale. Gower's sign was positive. An electromyogram showed myopathic changes and a nerve conduction velocity study was normal. Serum enzymes were elevated further on the third day: AST, 55 IU/L; CPK, 783 IU/L with 100% MM form. The diagnosis of dermatomyositis was established. As for the work-up result, anti-dsDNA antibody, anti-ENA antibody, and anti-Jo1 antibody were negative. Tumor marker screen (,-HCG, AFP, CEA, and CA-125), was negative, and rhinolaryngopharyngoscope examination and gynecologic sonography were normal. Figure 1. Diffuse erythematous swelling with subtle violaceous hue extending from the temporal area to the cheeks, neck, and shoulders. The crusted lip ulcers of herpes simplex were also noted Figure 2. Basketweave hyperkeratosis, mild acanthosis, subtle vacuolar degeneration of the basal cells, and melanin incontinence (hematoxylin and eosin, ×400) Figure 3. Heavy mononuclear cells infiltrated in the subcutaneous fat tissue (hematoxylin and eosin, ×100) Pancreatitis was initially suspected because of epigastric pain and tenderness, elevated serum lipase (382 U/L; normal, 23,200 U/L), and amylase (145 U/L; normal, 35,118 U/L). No evidence of pancreatitis could be found in abdominal sonography and abdominal computed tomography (CT), however. The epigastric pain and tenderness subsided soon after admission and the serum pancreatic enzyme level declined on the second day (amylase 69 U/L; lipase, 276 U/L). The patient was then diagnosed with dermatomyositis and treated with prednisolone (120 mg/day). CPK dropped dramatically from 3286 IU/L the day before treatment to 1197 IU/L 3 days after. Panniculitis lessened and the muscle power improved after 1 week of treatment. The disease activity fluctuated even with treatment with prednisolone and the patient often felt listless and weak. The muscle weakness sometimes deteriorated to affect the patient's mobility. Facial erythema and panniculitis-like lesions were found during the worse times. Methotrexate and azathioprine were then added (7.5 mg and 250 mg per week, respectively), but CPK was still mildly elevated (189 IU/L), and the patient still felt ill. Human immune globulin (5%, 500 mL per day, 5 days per month) intravenous infusion was initiated thereafter. There was a dramatic response. Full muscle strength was retained and CPK was within the normal range in the following 6 months with only immune globulin therapy. [source] A systematic review of nursing contributions to mobility rehabilitation: examining the quality and content of the evidenceJOURNAL OF CLINICAL NURSING, Issue 11c 2007Rosie Kneafsey BSc Aims., This paper summarizes the results of a systematic literature review to examine the quality and content of the evidence relating to nursing approaches to improving the mobility and movement of older people. Background., Older people experiencing health breakdown often develop problems with movement and mobility and nurses play a role in helping patients to either adapt to or overcome these difficulties. Methods., Electronic searches were undertaken of Medline, CINAHL, Amed and Cochrane Database of systematic reviews. Papers about nursing approaches to promoting mobility and movement were critically appraised using quality assessment checklists. Papers addressing safe moving and handling, falls prevention, health promotion, rehabilitation or teamworking in general were excluded. Results., Sixteen research and 33 informational papers were included and comprise the review. Many research papers used weak designs and small sample sizes, limiting their ability to control for important confounding variables. Although numerous studies examined effectiveness, only one used a randomised controlled trial design. Papers were grouped into four interlinked sets. These were promoting mobility and preventing immobility; walking and exercise; neuro-developmental principles; and rehabilitation patient handling. Conclusions., Specific foci for nursing assessment and interventions to promote patients' mobility have been identified. However, the fragmented nature of the evidence makes it difficult to make recommendations for nursing practice. Future research should be conducted by multi-professional research teams to identify the most effective approaches to promoting patients' mobility and to explore overlaps between different members of the rehabilitation team. Relevance to clinical practice., Regaining the ability to move and walk is often a key concern for patients who have suffered health breakdown. Although nurses provide patients with assistance the evidence available does little to direct nurses as to the best approach towards mobility rehabilitation. It is important that nurses play a role in measuring the efficacy of different interventions to promote rehabilitation. [source] | ||||||||||