Rehabilitation Program (rehabilitation + program)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Rehabilitation Program

  • cardiac rehabilitation program


  • Selected Abstracts


    Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program

    PAIN MEDICINE, Issue 9 2010
    Kathleen M. Darchuk PhD
    Abstract Objective., This study examined depression, pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary pain rehabilitation center compared with middle and younger age groups. Design., Quasi-experimental time series. Setting., Interdisciplinary pain rehabilitation center at a tertiary referral medical center. Patients., In total, 411 patients with chronic non-cancer pain completed the pain rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40,59; n = 230) and younger (ages 18,39; n = 141). Intervention., A 3-week outpatient interdisciplinary pain rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. Outcome Measures., The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results., Older patients reported reduced depression, catastrophizing, pain severity, and pain interference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up (P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. Conclusion., Interdisciplinary pain rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic pain patients. [source]


    Immediate Benefits of a Brief 10-Minute Exercise Protocol in a Chronic Pain Population: A Pilot Study

    PAIN MEDICINE, Issue 4 2010
    Amy Burleson Sullivan PsyD
    Abstract Objective., Determining the acute effects of a brief, 10-minute exercise protocol on pain, mood, and perceived exertion. Patients., Twenty-eight subjects who were admitted to the Cleveland Clinic Chronic Pain Rehabilitation Program (CPRP), and who were capable of completing an experimenter-designed and controlled treadmill protocol were included in this pilot study. Methods., A within-group repeated measure analysis was used to compare 28 subjects admitted to the Cleveland Clinic CPRP. Measures of heart rate were obtained using the Nellcor Oximax, pulse oximeter; measures of mood and pain were obtained using a 0,10 Likert scale, and perceived exertion measured with a visual analog scale. Each measure was taken pre- and post-10-minute exercise protocol. Results., The brief exercise protocol was associated with self-report of immediate antidepressant and anxiolytic effects. Additionally, after the 3-week CPRP, self-reports in perceived exertion decreased. Brief exercise was not found to have an acute analgesic effect. Conclusion., This preliminary research revealed a temporal association of improvement in self-rated anxiety and depression, following a brief exercise protocol, and over the course of 3 weeks leads to decreased perceived exertion. Therefore suggesting that brief exercise is a safe, nonpharmacologic strategy for immediately improving mood, and has further implications for mortality risk. [source]


    Reduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6-Month Follow-Up Medication Costs

    PAIN MEDICINE, Issue 5 2009
    Julie L. Cunningham PharmD
    ABSTRACT Objective., Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. Design., This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results., Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). Conclusion., Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs. [source]


    A Multicriteria Decision Support Methodology for Annual Rehabilitation Programs of Water Networks

    COMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 7 2007
    Pascal Le Gauffre
    A first set of criteria is formulated for the purpose of comparing and ranking rehabilitation projects. Each proposed criterion is a measure of a particular impact of the condition of a pipe. The ELECTRE TRI method is implemented for defining rehabilitation priorities. Two reference profiles are used to define the limits of three categories associated with three increasing priority levels. With these two reference profiles, applying the ELECTRE TRI method to an asset stock (a set of pipes that are candidates for rehabilitation) means assigning each pipe to one of six possible priority groups. A second set of criteria, based on the concept of efficiency, is proposed for comparing alternative rehabilitation programs (subsets of the asset stock). [source]


    Penile Rehabilitation after Radical Prostatectomy: Where Do We Stand and Where Are We Going?

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4ii 2007
    FACS, Run Wang MD
    ABSTRACT Introduction., Postprostatectomy erectile dysfunction (ED) remains a serious quality-of-life issue. Recent advances in the understanding of the mechanism of postprostatectomy ED have stimulated great attention toward penile rehabilitation. Aim., This review presents and analyzes a contemporary series of the recent medical literature pertaining to penile rehabilitation therapy after radical prostatectomy (RP). Main Outcome Measures., The laboratory and clinical studies related to penile rehabilitation are analyzed. The validity of the methodology and the conclusion of the findings from each study are determined. Methods., The published and presented reports dealing with penile rehabilitation following RP in human and cavernous nerve injury in animal models are reviewed. Results., Exciting scientific discoveries have improved our understanding of postprostatectomy ED at the molecular level. The rationale for postprostatectomy penile rehabilitation appears to be logical according to animal studies. However, clinical studies have not consistently replicated the beneficial effects found in the laboratory studies. Currently available clinical studies are flawed due to short-term follow-up, small number of patients in the studies, studies with retrospective nature, or prospective studies without control. Rehabilitation programs are also facing a challenge with the compliance, which is critical for success for any rehabilitation program. At the present time, we do not have concrete evidence to recommend what, when, how long, and how often a particular penile rehabilitative therapy can be used effectively. Conclusions., Large prospective, multicentered, placebo-controlled trials with adequate follow-up are necessary to determine the cost-effective and therapeutic benefits of particular penile rehabilitative therapy or therapies in patients following the treatment of clinically localized prostate cancer. Until such evidence is available, it is difficult to recommend any particular penile rehabilitation program as a standard of practice. Wang R. Penile rehabilitation after radical prostatectomy: Where do we stand and where are we going? J Sex Med 2007;4:1085,1097. [source]


    Prognostic Value of Exercise Stress Test and Dobutamine Stress Echo in Patients with Known Coronary Artery Disease

    ECHOCARDIOGRAPHY, Issue 1 2009
    Francesca Innocenti M.D.
    Background: The aim of this study was to compare the feasibility of dobutamine stress echocardiography (DSE) and exercise stress test (EST) between patients in different age groups and to evaluate their proportional prognostic value in a population with established coronary artery disease (CAD). Methods: The study sample included 323 subjects, subdivided in group 1 (G1), comprising 246 patients aged <75 years, and group 2 (G2), with 77 subjects aged ,75 years. DSE and EST were performed before enrollment in a cardiac rehabilitation program; for prognostic assessment, end points were all-cause mortality and hard cardiac events (cardiac death or nonfatal myocardial infarction). Results: During DSE, G2 patients showed worse wall motion score index (WMSI), but the test was stopped for complications in a comparable proportion of cases (54 G1 and 19 G2 patients, P = NS). EST was inconclusive in similarly high proportion of patients in both groups (76% in G1 vs. 84% in G2, P = NS); G2 patients reached a significantly lower total workload (6 ± 1.6 METs in G1 vs. 5 ± 1.2 METs in G2, P < 0.001). At multivariate analysis, a lower peak exercise capacity (HR 0.566, CI 0.351,0.914, P = 0.020) was associated with higher mortality, while a high-dose WMSI >2 (HR 5.123, CI 1.559,16.833, P = 0.007), viability (HR 3.354, CI 1.162,9.678, P = 0.025), and nonprescription of beta-blockers (HR 0.328, CI 0.114,0.945, P = 0.039) predicted hard cardiac events. Conclusion: In patients with known CAD, EST and DSE maintain a significant prognostic role in terms of peak exercise capacity for EST and of presence of viability and an extensive wall motion abnormalities at peak DSE. [source]


    Endurance Exercise Training in Older Patients with Heart Failure: Results from a Randomized, Controlled, Single-Blind Trial

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009
    Peter H. Brubaker PhD
    OBJECTIVES: To test the hypothesis that exercise training (ET) improves exercise capacity and other clinical outcomes in older persons with heart failure with reduced ejection fraction (HfrEF). DESIGN: Randomized, controlled, single-blind trial. SETTING: Outpatient cardiac rehabilitation program. PARTICIPANTS: Fifty-nine patients aged 60 and older with HFrEF recruited from hospital records and referring physicians were randomly assigned to a 16-week supervised ET program (n=30) or an attention-control, nonexercise, usual care control group (n=29). INTERVENTION: Sixteen-week supervised ET program of endurance exercise (walking and stationary cycling) three times per week for 30 to 40 minutes at moderate intensity regulated according to heart rate and perceived exertion. MEASUREMENTS: Individuals blinded to group assignment assessed four domains pivotal to HFrEF pathophysiology: exercise performance, left ventricular (LV) function, neuroendocrine activation, and health-related quality of life (QOL). RESULTS: At follow-up, the ET group had significantly greater exercise time and workload than the control group, but there were no significant differences between the groups for the primary outcomes: peak exercise oxygen consumption (VO2 peak), ventilatory anaerobic threshold (VAT), 6-minute walk distance, QOL, LV volumes, EF, or diastolic filling. Other than serum aldosterone, there were no significant differences after ET in other neuroendocrine measurements. Despite a lack of a group "training" effect, a subset (26%) of individuals increased VO2 peak by 10% or more and improved other clinical variables as well. CONCLUSION: In older patients with HFrEF, ET failed to produce consistent benefits in any of the four pivotal domains of HF that were examined, although the heterogeneous response of older patients with HFrEF to ET requires further investigation to better determine which patients with HFrEF will respond favorably to ET. [source]


    Role of executive dysfunction in predicting frequency and severity of violence

    AGGRESSIVE BEHAVIOR, Issue 5 2010
    Megan Hancock
    Abstract The adverse consequences of violence on society are tremendous. The proportion of offenders incarcerated for violent offenses is large, and the cost of keeping these offenders incarcerated is startling. Understanding and treating the causal underpinnings of violent crime is of utmost importance for individuals and society as a whole. Several factors have been identified as potential contributors to violent crime, including cognitive deficits in executive functioning [Hoaken et al., 2007]. To investigate this further, 77 offenders from Fenbrook Institution, a federal facility, were tested on a battery of executive functioning measures. Offenders were found to have broad and pervasive dysfunction in their executive abilities. In addition, specific scores from the battery were found using regression techniques, to predict the frequency and severity of past violent offending but not nonviolent offending. This speaks of the possibility of a new type of correctional rehabilitation program, one that focuses on the rehabilitation of basic executive functions. Aggr. Behav. 36:338,349, 2010. © 2010 Wiley-Liss, Inc. [source]


    "A Disease of Frozen Feelings":

    MEDICAL ANTHROPOLOGY QUARTERLY, Issue 3 2010
    Ethically Working on Emotional Worlds in a Russian Orthodox Church Drug Rehabilitation Program
    In a Russian Orthodox Church drug rehabilitation program in St. Petersburg, drug addiction was often described as a disease of frozen feelings. This image suggests that rehabilitation is a process of thawing emotional worlds and, thus, allows the emotions to flow once again. In this article I argue that "frozen feelings" is better understood as the unsocial emotional worlds many drug users experience, and that rehabilitation in this church-run program particularly focuses on the cultivation of an emotional world that supports sociality. This is done, I argue, by means of ethically training rehabilitants to learn how to control and manage their emotional worlds, and in so doing, rehabilitants become new moral persons better able to live in the social world. [source]


    Longitudinal Treatment Outcomes for Geriatric Patients with Chronic Non-Cancer Pain at an Interdisciplinary Pain Rehabilitation Program

    PAIN MEDICINE, Issue 9 2010
    Kathleen M. Darchuk PhD
    Abstract Objective., This study examined depression, pain catastrophizing, psychosocial functioning, and physical and emotional health attributes for geriatric patients admitted to an interdisciplinary pain rehabilitation center compared with middle and younger age groups. Design., Quasi-experimental time series. Setting., Interdisciplinary pain rehabilitation center at a tertiary referral medical center. Patients., In total, 411 patients with chronic non-cancer pain completed the pain rehabilitation program from October 2004 to April 2006. Patients were divided into three groups based on age: older (ages 60+; n = 78); middle-age (ages 40,59; n = 230) and younger (ages 18,39; n = 141). Intervention., A 3-week outpatient interdisciplinary pain rehabilitation program based on a cognitive-behavioral model that incorporates opioid withdrawal. Outcome Measures., The Multidimensional Pain Inventory (MPI), Short Form-36 Health Status Questionnaire (SF-36), Pain Catastrophizing Scale (PCS), and Center for Epidemiological Studies-Depression Scale (CES-D) were administered at admission, discharge, and 6 months following treatment. The frequency of patients using opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and benzodiazepines at each assessment point were compared. Results., Older patients reported reduced depression, catastrophizing, pain severity, and pain interference (P < 0.001) at discharge and 6 months follow-up. Older patients also reported increased perceived control, and physical and social functioning at discharge and follow-up (P < 0.001). Improvement in older patients was comparable in magnitude to that of middle-age patients on all variables, whereas younger patients exhibited greater improvement on four variables. Significant reductions in analgesic use were observed in all groups. Conclusion., Interdisciplinary pain rehabilitation incorporating opioid withdrawal can improve long-term psychological, social and physical functioning for geriatric chronic pain patients. [source]


    Reduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6-Month Follow-Up Medication Costs

    PAIN MEDICINE, Issue 5 2009
    Julie L. Cunningham PharmD
    ABSTRACT Objective., Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. Design., This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results., Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). Conclusion., Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs. [source]


    Reduced Cold Pain Tolerance in Chronic Pain Patients Following Opioid Detoxification

    PAIN MEDICINE, Issue 8 2008
    Jarred Younger PhD
    ABSTRACT Objective., One potential consequence of chronic opioid analgesic administration is a paradoxical increase of pain sensitivity over time. Little scientific attention has been given to how cessation of opioid medication affects the hyperalgesic state. In this study, we examined the effects of opioid tapering on pain sensitivity in chronic pain patients. Design., Twelve chronic pain patients on long-term opioid analgesic treatment were observed in a 7- to 14-day inpatient pain rehabilitation program, with cold pain tolerance assessed at admission and discharge. The majority of participants were completely withdrawn from their opioids during their stay. Outcome Measures., We hypothesized that those patients with the greatest reduction in daily opioid use would show the greatest increases in pain tolerance, as assessed by a cold pressor task. Results., A linear regression revealed that the amount of opioid medication withdrawn was a significant predictor of pain tolerance changes, but not in the direction hypothesized. Greater opioid reduction was associated with decreased pain tolerance. This reduction of pain tolerance was not associated with opioid withdrawal symptoms or changes in general pain. Conclusions., These findings suggest that the withdrawal of opioids in a chronic pain sample leads to an acute increase in pain sensitivity. [source]


    PAIN REDUCTION WITH OPIOID ELIMINATION

    PAIN MEDICINE, Issue 2 2002
    Article first published online: 4 JUL 200
    Edward Covington, MD, Cleveland Clinic Foundation; Margaret Kotz, DO, Cleveland Clinic Foundation The last decade has seen a reversal of the historical belief that chronic opioid therapy (COT) was inadvisable in nonmalignant palm. Numerous studies demonstrate sustained pain reduction with chronic opioid therapy; however, there are clinical reports and animal models that suggest chronic opioids may at times exacerbate pain. Clearly, many patients without apparent structural deficit have persistent pain and dysfunction despite high dose opioid therapy. Thus, while opioids have been shown to be safe in long term use, the question of efficacy remains. Predictors of success in COT are not fully established. Studies of intrathecal opioids suggest that high levels of patient satisfaction and retrospective reports of benefit may occur despite minimal change in pain level and function. This raises the question of whether at times the purported benefits of long-term opioid therapy may be illusory. Consecutive admissions to a chronic pain rehabilitation program (n = 228) were studied. This program represents a biased population in that many referrals have dysfunction that is discordant with pathology, inordinate suffering and dysphoria, poorly explained pain, or substance use problems. Of 228, 56 were taking , 100 mg p.o. morphine equivalents/d on admission (mean 456 mg/d). Data are available on 46 of these receiving ,high dose' opioids. Patients participated in a rehabilitation program that included reconditioning, cognitive behavioral psychotherapy, adjuvant medications, and elimination of opioids and benzodiazepines. 43 (93%) experienced a reduction in pain with opioid elimination (from 7.2 to 4.0/10). Three experienced an increase in pain. Depression and functional impairment also improved. Cases will be presented of patients who believed they were benefiting from chronic opioid therapy, but improved after opioid elimination. They commonly described "getting myself back" after elimination of opioids. Physiological considerations and treatment implications will be described. [source]


    (616) Osteoporosis in Men-An Overlooked Source of Spine Pain, A Case Study and State-of-the-art Review

    PAIN MEDICINE, Issue 2 2000
    Article first published online: 25 DEC 200
    Author: Toni J Hanson, Mayo Clinic Osteoporosis is a significant cause of morbidity in the USA. It is estimated that $84 billion annually is spent in the care of osteoporotic fractures. Diagnosis and treatment of osteoporosis in males has lagged and has only recently been recognized as an important issue, which is certain to become more significant as the population ages. A case study of a 47-year-old male with low back pain is presented. His spine x-rays revealed wedge-compression fractures of the spine; and a bone mineral density was obtained. The bone mineral density revealed a value of 0.80 g/cm2 at the lumbar spine and 0.7 g/cm2 at the hip, with T-scores respectively of ,2.89 in the spine and ,1.69 in the hip, consistent with a diagnosis of osteoporosis. He was evaluated in the Metabolic Bone Clinic. His daily calcium intake was noted to be 400 mg to 500 mg per day. Risk factor assessment revealed a remote use of excessive alcohol until age 26, and remote less significant history of smoking. Additional laboratory tests were negative for a secondary etiology. He was treated with Fosamax, calcium, and vitamin D supplementation. His physical medicine and rehabilitation program is illustrated. In addition, vocational issues are described. A comprehensive review of the literature regarding osteoporosis in males including diagnosis, treatment, and references is provided. [source]


    Epidural Infusion of Opiates and Local Anesthetics for Complex Regional Pain Syndrome

    PAIN PRACTICE, Issue 2 2002
    Sami Moufawad MD
    CRPS-I consists of multiple signs, including autonomic dysfunction, in the form of edema, vasomotor changes, motor dysfunctions, muscle spasms, tremors and dystonia, as well as burning pain, hypersensitivity and allodynia that could present in any combination. The treatment is progressive physical therapy rehabilitation program. Multiple analgesic modalities have been used to facilitate the rehabilitation program with varying rates of success. The most successful treatment is a multi-disciplinary comprehensive approach, where initial pain control allows for physical and psychological interventions that are believed to be the basis for successful treatment.1 The pain in CRPS-I may be mediated through the sympathetic nervous system, sympathetic maintained pain (SMP) or sympathetic independent pain (SIP)2. [source]


    Effects of a short-term rehabilitation program on airway inflammation in children with cystic fibrosis,,

    PEDIATRIC PULMONOLOGY, Issue 6 2010
    Alexander Moeller MD
    Abstract Background Respiratory therapy in cystic fibrosis (CF) consists of airway clearance, infection control, and reduction of airway inflammation. It is well recognized that physical activity as well as daily chest physiotherapy, enhance airway clearance. We investigated the effects of pulmonary rehabilitation, including physical activity and chest physiotherapy, on airway inflammation in children with CF. Methods Eighteen children with stable CF (six females), aged 8.2,16.2 years, participating in a 3-week multidisciplinary inpatient rehabilitation program were recruited. Assessment at the beginning and the end of the program included clinical score, pulmonary function test, exhaled breath condensate (EBC) and sputum analysis. Sputum supernatant and EBC were analyzed for interleukin (IL)-1b, 6, 8, 10, 12, tumor necrosis factor-alpha (TNF-,) and LTB4. Results Median (IQR) symptom scores decreased from 19 [23] to 16 [21], P,=,0.005. Vital capacity and FVC increased significantly (P,<,0.05). However no difference was found for the total sputum cells and sputum as well as EBC cytokines between the two visits. Significant correlations were found for sputum IL-1 (+), IL-6 (,), and IL-8 (+) to total sputum cell count and neutrophils and for IL-8 to TNF-,. Conclusions We have shown that a short-term inpatient rehabilitation for children with stable CF with intensive physical activity mainly improve subjective clinical symptoms and measures of lung function such as VC and FVC but does not influence airflow obstruction and airway inflammation as assessed by sputum and EBC analysis. Pediatr Pulmonol. 2010; 45:541,551. © 2010 Wiley-Liss, Inc. [source]


    Coronary Risk Factor Management in the Framework of a Community Hospital-Based Ambulatory Exercise Training Program

    PREVENTIVE CARDIOLOGY, Issue 2 2004
    Morton Leibowitz MD
    Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk-factor management is limited. The authors measured the ability of a community hospital-based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk-factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3-month period of training and counseling by a multidisciplinary team with follow-up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty-two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low-density lipoprotein cholesterol level (,4.5%), high-density lipoprotein cholesterol level (+7%), body mass index (,2%), systolic blood pressure (,3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital-based risk management exercise program is an effective method for improving the long-term management of patients with chronic ischemic heart disease. [source]


    Using Macrophytes in Urban Stream Rehabilitation: A Cautionary Tale

    RESTORATION ECOLOGY, Issue 6 2009
    Alastair M. Suren
    Abstract Native macrophytes were transplanted into a small urban stream as part of a rehabilitation program, that also meandered the previously channeled stream, naturalized stream banks, and planted native riparian vegetation. Transplanted macrophytes minimized spread of introduced macrophytes and were viewed beneficially by residents, as was the stream rehabilitation. We transplanted the native macrophyte Myriophyllum triphyllum into five larger streams dominated by exotic macrophytes,some of which were weeded prior to transplanting,to see whether Myriophyllum could prevent regrowth of weeded plants. Transplanted Myriophyllum plants were washed away in two streams, reflecting high shear stresses there. Myriophyllum cover in the other streams decreased as weeded plants regrew. Our attempt at eliminating exotic macrophytes in patches in large streams was unsuccessful. Furthermore, council authorities weeded other experimental sections following complaints from residents of excess macrophyte growth. This problem highlighted conflicting multiple values placed on urban streams by managers and the public. A repeat survey of residents living near the original rehabilitated stream showed that many respondents were now critical of excessive plant growth,both in-stream and riparian. A recurring comment made concerned the apparent lack of maintenance to the stream, giving it an untidy appearance. Difficulties with propagating and transplanting native macrophytes into larger streams, coupled with a negative perception of native vegetation (both in-stream and riparian) if it looks unmanaged, suggest that planting macrophytes or riparian plants as part of urban stream rehabilitation programs may be more problematic than realized. [source]


    ORIGINAL RESEARCH,WOMEN'S SEXUAL HEALTH: Biofeedback, Electrical Stimulation, Pelvic Floor Muscle Exercises, and Vaginal Cones: A Combined Rehabilitative Approach for Sexual Dysfunction Associated with Urinary Incontinence

    THE JOURNAL OF SEXUAL MEDICINE, Issue 6 2009
    Massimo Rivalta MD
    ABSTRACT Introduction., Urinary incontinence (UI) is often associated with sexual dysfunction. We present our preliminary experience with a combined rehabilitative approach consisting of biofeedback, functional electrical stimulation, pelvic floor muscle exercises, and vaginal cones. Aim., The potential impact of such practice on UI and sexual function was analyzed in our case series and discussed. Main Outcome Measures and Methods., We evaluated three women affected by UI and sexual dysfunction. The patients underwent combined pelvic floor rehabilitation (PFR), kept voiding diaries, and filled out the Female Sexual Function Index (FSFI questionnaire) before and after the completion of PFR. We evaluated each domain score, including desire, arousal, lubrication, orgasm, satisfaction, and pain. Results., After the combined rehabilitation program, none of them had UI requiring pad use or referred urine leakage during sexual activity, including intercourse. Before PFR, FSFI score ranged from 16 to 21; after treatment, the FSFI score ranged from 22.1 to 29.3. There was an improvement in patients regarding desire, arousal, lubrication, orgasm, satisfaction, and pain. Conclusions., A complete rehabilitation can provide a beneficial effect on sexual function. A larger trial, on a more extended female population, is currently in progress, in order to confirm our findings. The effectiveness of a complete PFR scheme, together with the lack of side effects, makes it a suitable approach to sexual dysfunction that is associated with UI. Rivalta M, Sighinolfi MC, De Stefani S, Micali S, Mofferdin A, Grande M, and Bianchi G. Biofeedback, electrical stimulation, pelvic floor muscle exercises, and vaginal cones: A combined rehabilitative approach for sexual dysfunction associated with urinary incontinence. J Sex Med 2009;6:1674,1677. [source]


    Penile Rehabilitation after Radical Prostatectomy: Where Do We Stand and Where Are We Going?

    THE JOURNAL OF SEXUAL MEDICINE, Issue 4ii 2007
    FACS, Run Wang MD
    ABSTRACT Introduction., Postprostatectomy erectile dysfunction (ED) remains a serious quality-of-life issue. Recent advances in the understanding of the mechanism of postprostatectomy ED have stimulated great attention toward penile rehabilitation. Aim., This review presents and analyzes a contemporary series of the recent medical literature pertaining to penile rehabilitation therapy after radical prostatectomy (RP). Main Outcome Measures., The laboratory and clinical studies related to penile rehabilitation are analyzed. The validity of the methodology and the conclusion of the findings from each study are determined. Methods., The published and presented reports dealing with penile rehabilitation following RP in human and cavernous nerve injury in animal models are reviewed. Results., Exciting scientific discoveries have improved our understanding of postprostatectomy ED at the molecular level. The rationale for postprostatectomy penile rehabilitation appears to be logical according to animal studies. However, clinical studies have not consistently replicated the beneficial effects found in the laboratory studies. Currently available clinical studies are flawed due to short-term follow-up, small number of patients in the studies, studies with retrospective nature, or prospective studies without control. Rehabilitation programs are also facing a challenge with the compliance, which is critical for success for any rehabilitation program. At the present time, we do not have concrete evidence to recommend what, when, how long, and how often a particular penile rehabilitative therapy can be used effectively. Conclusions., Large prospective, multicentered, placebo-controlled trials with adequate follow-up are necessary to determine the cost-effective and therapeutic benefits of particular penile rehabilitative therapy or therapies in patients following the treatment of clinically localized prostate cancer. Until such evidence is available, it is difficult to recommend any particular penile rehabilitation program as a standard of practice. Wang R. Penile rehabilitation after radical prostatectomy: Where do we stand and where are we going? J Sex Med 2007;4:1085,1097. [source]


    Supracricoid Laryngectomy Outcomes: The Johns Hopkins Experience

    THE LARYNGOSCOPE, Issue 1 2007
    Tarik Y. Farrag MD
    Abstract Objective: To report the oncologic and functional results from our experience in performing supracricoid laryngectomy (SCL) for selected patients with laryngeal cancer. Study Design: Retrospective chart review. Methods: Twenty-four consecutive patients who underwent SCL for laryngeal cancer in our institution from December 2000 to March 2006 have been reviewed. Reports of the site and extent of tumor, type of reconstruction, preoperative or postoperative radiotherapy, and the final histopathologic examination were reviewed. In addition, the reports of the preoperative examination, inpatient course, and postoperative follow-up were reviewed. Results: A total of 24 patients were involved in the study; 19 had tumors involving the glottic region, and 5 patients had tumors involving both the glottic and supraglottic regions (transglottic). Ten patients had their SCL for postradiotherapy recurrence/persistence of disease. Eighteen patients underwent reconstruction through cricohyoidoepiglottopexy (CHEP), whereas six patients had cricohyoidopexy (CHP). Eleven patients had an arytenoid cartilage resected; 8 of 11 had CHEP, and 3 of 11 had CHP. All patients had a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement performed at the same time as the SCL. The median hospital stay period was 6 days. Twenty-three of 24 had successful tracheostomy tube decannulation, with a median time to decannulation of 37 days. The median time to removal of the PEG tube was 70 days. The complications with SCL were postoperative wound infection in two patients (SCL/CHP) and the need for completion total laryngectomy secondary to intractable aspiration in one patient with SCL/CHP. One patient with SCL/CHEP had a ruptured pexy and subsequently underwent a second reconstruction with successful tracheostomy and PEG tube removal. One of 24 patients is still PEG tube dependant, and he had postoperative radiotherapy. Fifteen patients underwent concurrent neck dissection. None of the patients had any local or regional recurrence, with a median follow-up period of 3 years. All final surgical margins were negative for tumor invasion. Three patients had postoperative radiotherapy, two patients because of nodal metastases in the excised lymph nodes and one because of perineural invasion on final histopathologic examination of the SCL specimen. There were no perioperative deaths. Conclusion: SCL with CHEP or CHP represents an effective technique that can be taught and effectively used to avoid a total laryngectomy while maintaining physiologic speech and swallowing in selected patients with advanced stage primary laryngeal cancer or recurrent/persistent laryngeal cancer after radiotherapy. There is a good functional recovery with acceptable morbidity and an excellent oncologic outcome when strict selection criteria are applied and a formal swallowing rehabilitation program is followed. [source]


    Inpatient multidisciplinary rehabilitation after hip fracture for residents of nursing homes: A randomised trial

    AUSTRALASIAN JOURNAL ON AGEING, Issue 1 2008
    Cesar Uy
    Objective:,To determine the effectiveness of interdisciplinary rehabilitation for women with hip fracture who were residents of nursing homes. Design:,Randomised controlled trial. Subjects:,Eleven cognitively impaired women with hip fracture who were previously ambulant. Methods:,Participants were randomly allocated to usual care (discharge back to the nursing home soon after surgery to the hip fracture) or an inpatient interdisciplinary rehabilitation program. Results:,Participants were severely cognitively impaired and the majority used a walking aid prior to fracturing their hip. There was one early death, and at final follow up (4 months after hip fracture) median (range) Barthel Index was 28 (0,82) for control group and 68 (0,88) for the intervention group. Conclusion:,No definite conclusion can be drawn about the effectiveness of the intervention because of its premature termination. However, the study established that it is feasible to provide an interdisciplinary rehabilitation for older people with hip fracture and severe disablement. [source]


    Medical management of significant coronary angiographic stenoses: Outcome of 60 patients observed for 433 patient years

    CLINICAL CARDIOLOGY, Issue 8 2000
    Charles L. Baird Jr. M.D.
    Abstract Background: Percutaneous transluminal coronary angioplasty (PTCA) has become routine in the management of patients with stable angina pectoris and significant coronary stenoses, while medical management of such patients has declined. Hypothesis: The purpose of the present study was to evaluate the outcome of 60 patients at the Virginia Heart Institute with stable angina pectoris, observed between 1976 and 1997, who had documented evidence of severe angiographic disease but were elected to be monitored and managed in an outpatient pharmacologic rehabilitation program. Methods: Sixty patients with significant stenoses by coronary angiography (21 with single-vessel, 26 with double-vessel, and 13 with triple-vessel) without impaired ventricular function, exercise-induced ischemia or hypotension, limited exercise performance, malignant arrhythmias, or drug intolerance were enrolled in a program of pharmacologic rehabilitation and observed for an average of 7.2 years. Results: Among the 60 patients, there were 6 deaths at a mean interval of 8.3 years. Two deaths were in patients ineligible for revascularization. Another patient who died had refused revascularization after new-onset left ventricular dysfunction, and another died intraoperatively during abdominal aortic aneurysm repair. Two patients died while exercising. Thirteen patients underwent follow-up catheterization for worsening angina; 11 of 13 showed progression, predominantly from new lesions. Four of 11 were referred for revascularization; 7 of 11 continued medical treatment; 49 patients were stable on medical therapy throughout the period of observation. Conclusion: Medical management of selected patients with significant coronary stenoses is safe and effective. [source]


    A Multicriteria Decision Support Methodology for Annual Rehabilitation Programs of Water Networks

    COMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 7 2007
    Pascal Le Gauffre
    A first set of criteria is formulated for the purpose of comparing and ranking rehabilitation projects. Each proposed criterion is a measure of a particular impact of the condition of a pipe. The ELECTRE TRI method is implemented for defining rehabilitation priorities. Two reference profiles are used to define the limits of three categories associated with three increasing priority levels. With these two reference profiles, applying the ELECTRE TRI method to an asset stock (a set of pipes that are candidates for rehabilitation) means assigning each pipe to one of six possible priority groups. A second set of criteria, based on the concept of efficiency, is proposed for comparing alternative rehabilitation programs (subsets of the asset stock). [source]


    Comparative study of sexuality-related characteristics in young adults with schizophrenia treated with novel neuroleptics and in normal young adults

    ACTA PSYCHIATRICA SCANDINAVICA, Issue 2002
    P. Fortier
    This study compared characteristics related to sexual history, sexual activities, sexual functioning and psychological tendencies associated with sexuality in 45 young adults with schizophrenia treated with novel neuroleptics and 61 control young adults. A smaller proportion of young adults with schizophrenia currently had a sexual partner or had ever engaged in sexual relations. They also had sexual relations and sexual desires less often. Whether affected by schizophrenia or not, a smaller proportion of women had ever masturbated. They felt less sexual desire and desired sexual relations less often. Compared to controls, a higher proportion of men with schizophrenia treated with Risperidone or Olanzapine had at least one sexual dysfunction, lacked sexual desire and reported problems with sexual arousal and ejaculation. Women with schizophrenia were more likely to report problems with sexual arousal and galactorrhea. Finally, young adults with schizophrenia develop more negative psychological tendencies associated with sexuality than were normal young adults. Sexual problems are highly prevalent among young adults with schizophrenia. Sexuality should occupy the space it deserves within psychosocial rehabilitation programs and the treatment of schizophrenia. [source]


    Effectiveness of brief structured interventions on risk factor modification for patients with coronary heart disease: a systematic review

    INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2007
    Ritin Fernandez RN MN (Critical care) PhD Candidate
    Abstract Background, The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established. Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low. Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors. Objectives, The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease. Search strategy, A literature search was performed using the following databases MEDLINE (1966,2006), CINAHL (1982,2006), EMBASE (1980,current) and up to the Cochrane Controlled Trials Register (Issue 2, 2006 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. Company representatives, experts and investigators were contacted to elicit further information. Selection criteria, All randomised and quasi-randomised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were considered for inclusion in the review. Data collection and analysis, Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, trials were considered separately. Main results, Seventeen trials involving a total of 4725 participants were included in the final review: three trials compared the effects of brief structured interventions on diet modification; seven on smoking cessation; and seven on multiple risk factors. Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification. Although there was a tendency for more participants in the intervention arm to lose weight at the 12-week follow up and achieve target cholesterol levels at the 6-month follow up, these results were not statistically significant. Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention. However, no difference in fish, fruit and vegetable intake between the groups was evident. Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation. There was no difference in the smoking cessation rates at the 3- and 6-week follow up, however, there was evidence of a benefit of brief structured interventions for smoking cessation at the 3-, 6- and 12-month follow up. In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups. In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake, weight loss and consequently on reduction in the body mass index, smoking cessation and physical activity among the participants. The findings concerning the effect on blood pressure, blood glucose levels and the lipid profile, however, remain inconclusive. Conclusions, There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease. This review, however, supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease. Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors. [source]


    The impact of ethnicity on prospective functional outcomes from community-based psychosocial rehabilitation for persons with schizophrenia

    JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 6 2001
    Elizabeth S. Phillips
    Ethnicity was examined for its relationship to prospective functional outcomes from community-based psychosocial rehabilitation for individuals with schizophrenia. Participants were 98 individuals diagnosed with schizophrenia or schizoaffective disorder who were admitted to two community-based psychosocial rehabilitation programs. Previous studies had established that these programs were effective in improving functional outcomes. Data on hospitalization, independent living, social, and work functioning were collected every 6 months for a period of 3 years. The results using hierarchical linear modeling revealed significant differences among non-minorities, African Americans, and Latinos in rehabilitative change over time in the domains of work and social functioning. Non-minorities achieved the greatest gains in both social and work functioning. African Americans showed little change in social functioning, but showed a decline in work functioning. In the domain of work, Latinos deteriorated more than African Americans, and this was most notable for Latino males. There were no cross-ethnic differences in independent living or hospitalization outcomes. Based on these findings, there is important variation among different ethnic groups in their response to psychosocial rehabilitation. Implications are discussed in terms of the need for culturally relevant rehabilitation methods, and for research on cultural constructs in community-based intervention studies. © 2001 John Wiley & Sons, Inc. [source]


    Reduction in Medication Costs for Patients with Chronic Nonmalignant Pain Completing a Pain Rehabilitation Program: A Prospective Analysis of Admission, Discharge, and 6-Month Follow-Up Medication Costs

    PAIN MEDICINE, Issue 5 2009
    Julie L. Cunningham PharmD
    ABSTRACT Objective., Chronic nonmalignant pain (CNMP) is both a prevalent and a costly health problem in our society. Pain rehabilitation programs have been shown to provide cost-effective treatment. A treatment goal for some rehabilitation programs is reduction in the use of pain-related medication. Medication costs savings from pain rehabilitation programs have not been analyzed in previous studies. Design., This prospective cohort study of 186 patients with CNMP addresses the costs of medications at admission to a 3-week outpatient pain rehabilitation program, at discharge, and at 6-month follow-up. Medication use was determined through a detailed pharmacist interview with patients at admission and discharge. Patients were sent questionnaires 6 months after program completion, which obtained current medication information. Results., Statistically significant medication cost savings were seen for program completers at discharge and at 6-month follow-up (P < 0.05). The mean (standard deviation) daily prescription medication cost reduction from admission to discharge was $9.31 ($12.70) using the average wholesale price of medications. From the original study cohort, 121 patients completed the 6-month follow-up survey. The mean daily prescription medication cost savings from admission to 6-month follow-up was $6.68 ($14.40). Conclusion., Patients benefited from significant medication cost savings at the completion of the 3-week outpatient pain rehabilitation program and maintained significant savings after 6 months. This study adds to the current literature on the economic value of comprehensive pain rehabilitation programs. [source]


    Long-term cancer survivors experience work changes after diagnosis: results of a population-based study

    PSYCHO-ONCOLOGY, Issue 12 2009
    Floortje Mols
    Abstract Background: Although cancer survivorship is increasing with improved diagnosis and treatments, few studies have explored employment changes and the factors related to this change among cancer survivors. Therefore, we aim to explore the prevalence of employment problems in long-term cancer survivors. In addition, we explored what patient or tumour characteristics predicted employment changes. Methods: All 1893 long-term survivors of prostate cancer, endometrial cancer, non-Hodgkin's lymphoma, and Hodgkin's lymphoma diagnosed between 1989 and 1998 in the area of the Comprehensive Cancer Centre South, The Netherlands were included in a population-based cross-sectional survey. Results: Response rate was 80% (n=1511). After excluding survivors without a job before diagnosis, 403 survivors remained; 197 (49%) experienced no changes in their work situation following cancer diagnosis, 69 (17%) were working fewer hours, and 137 (34%) stopped working or retired. A medium educational level was significant in reducing the risk of work changes. Being older, having more than one comorbid condition, being treated with chemotherapy, and disease progression were significant independent predictors of work changes after cancer. Experiencing work changes was associated with lower physical functioning but positively associated with social well-being. Discussion: Long-term cancer survivors experience work changes after diagnosis and treatment, and clinical factors significantly predicted work change after cancer. As such, our study underscores the importance of rehabilitation programs in improving the return to work after cancer. Copyright © 2009 John Wiley & Sons, Ltd. [source]


    Using Macrophytes in Urban Stream Rehabilitation: A Cautionary Tale

    RESTORATION ECOLOGY, Issue 6 2009
    Alastair M. Suren
    Abstract Native macrophytes were transplanted into a small urban stream as part of a rehabilitation program, that also meandered the previously channeled stream, naturalized stream banks, and planted native riparian vegetation. Transplanted macrophytes minimized spread of introduced macrophytes and were viewed beneficially by residents, as was the stream rehabilitation. We transplanted the native macrophyte Myriophyllum triphyllum into five larger streams dominated by exotic macrophytes,some of which were weeded prior to transplanting,to see whether Myriophyllum could prevent regrowth of weeded plants. Transplanted Myriophyllum plants were washed away in two streams, reflecting high shear stresses there. Myriophyllum cover in the other streams decreased as weeded plants regrew. Our attempt at eliminating exotic macrophytes in patches in large streams was unsuccessful. Furthermore, council authorities weeded other experimental sections following complaints from residents of excess macrophyte growth. This problem highlighted conflicting multiple values placed on urban streams by managers and the public. A repeat survey of residents living near the original rehabilitated stream showed that many respondents were now critical of excessive plant growth,both in-stream and riparian. A recurring comment made concerned the apparent lack of maintenance to the stream, giving it an untidy appearance. Difficulties with propagating and transplanting native macrophytes into larger streams, coupled with a negative perception of native vegetation (both in-stream and riparian) if it looks unmanaged, suggest that planting macrophytes or riparian plants as part of urban stream rehabilitation programs may be more problematic than realized. [source]