Does Early Functional Outcome Predict 1-Year Mortality in Elderly Patients With Hip Fracture?
Does Early Functional Outcome Predict 1-year Mortality in Elderly Patients With Hip Fracture?
Clin Orthop Relat Res. 2013 Apr 2;
Dubljanin-Raspopovi? E, Markovi?-Deni? L, Marinkovi? J, Nedeljkovi? U, Bumbaširevi? M
BACKGROUND: Hip fractures in the elderly are followed by considerable risk of functional decline and mortality. QUESTIONS/PURPOSES: The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures. METHODS: A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables. RESULTS: Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture. CONCLUSIONS: Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. HubMed – rehab
Pulse waveform analysis as a bridge between pulse examination in Chinese medicine and cardiology.
Chin J Integr Med. 2013 Apr; 19(4): 307-14
de Sá Ferreira A, Lopes AJ
Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables (frequency, rhythm, wideness, length, deepness, and qualities) developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories: the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine – such as yinyang – while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiology to provide a more evidence-based medical practice. HubMed – rehab
Understanding the process of living as signified by myocardial revascularization surgery patients.
Rev Lat Am Enfermagem. 2013 Feb; 21(1): 332-9
Erdmann AL, Lanzoni GM, Callegaro GD, Baggio MA, Koerich C
To understand the meanings for the process of living, for patients undergoing myocardial revascularization surgery, and to construct an explanatory theoretical model.Grounded Theory was used, with data collection undertaken between October 2010 and May 2012, in a health institution which specializes in cardiac surgery, located in the south of Brazil. Thirty-three subjects were interviewed (patients, health care professionals and family members), distributed in four sample groups. Result: The explanatory theoretical model was comprised of 11 categories and the central phenomenon. The specialized service and the cardiac rehabilitation program formed the context, the discovery of the cardiac disease and the feelings experienced during the perioperative period were the cause and intervening conditions in the process of experiencing the myocardial revascularization surgery. The strategies were relying on the family’s support, having faith and hope, and participating in the rehabilitation program. This process’s main consequences were the confrontation of the changes and the resulting limitations, difficulties and adaptations to the new lifestyle after surgery.The process of experiencing the myocardial revascularization surgery constitutes an opportunity for maintaining the patient‘s life associated with the needs for confronting the significant changes in lifestyle. HubMed – rehab
Evaluating the feasibility of Goal Attainment Scaling as a rehabilitation outcome measure for veterans.
J Rehabil Med. 2013 Mar 28; 45(4): 403-9
Lewis VJ, Dell L, Matthews LR
Objective: The increasing number of veterans with complex health conditions accessing rehabilitation leads to the need for an outcome measure that identifies success in areas beyond return to work. The current study was designed to assess the feasibility of Goal Attainment Scaling as a routine measure of outcomes of rehabilitation. Methods: Fifteen organisations contracted by the Australian Department of Veterans’ Affairs to work with veterans were invited to trial Goal Attainment Scaling. Training was provided to rehabilitation professionals, and existing documentation was modified by the Australian Department of Veterans Affairs to introduce the Goal Attainment Scaling approach. Results: Analysis of the use of Goal Attainment Scaling supported the feasibility and potential usefulness of the tool in a veteran population. Rehabilitation providers set goals across a range of domains including medical, psychological, social, as well as return to work. The quality of the goals and the outcome measures was generally good. Conclusions: The Goal Attainment Scaling approach was seen to support a client-focussed approach to rehabilitation. Data obtained through the use of Goal Attainment Scaling can be summarised at different levels to be useful for clients, providers, rehabilitation coordinators, and senior executives to monitor and report on the overall success of the different types of rehabilitation provided to veteran clients. HubMed – rehab
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