Rehabilitation Medicine in the Neurosurgical Patient

2019 ◽  
pp. 233-264
Author(s):  
Catriona M. Harrop ◽  
Kristin Gustafson ◽  
Swathi Maddula ◽  
James Bresnehan ◽  
Philip Koehler
Keyword(s):  
Injured Patient ◽  
Recovery Process ◽  
Rehabilitation Medicine ◽  
Vital Role ◽  
Endocrine Disorders ◽  
Neurologic Injury ◽  
Care Needs ◽  
Neurosurgical Patient ◽  
Pressure Injury ◽  
Urological Disorders

The rehabilitation of the patient with neurologic injury encompasses a vital role in the recovery process for the patient. As hospitalists, it is essential that we understand the post-acute care needs of the neurologically injured patient, so that we can better prevent and treat sequela of neurologic injury. The chapter is split into two parts, addressing separately patients with brain injury and patients with spinal cord injury. Among the issues discussed are sleep disturbance disorders; musculoskeletal disorders; cardiovascular, respiratory, and GI disorders; urological disorders; nutrition; endocrine disorders; skin-related problems such as pressure injury, and bone-related disorders such as heterotopic ossification (HO).

Servicing the Senior Swallow: A Family-Centered Private Practice Model of Service Delivery

2020 ◽  
pp. 1-4 ◽  
Author(s):  
Yvette M. McCoy
Keyword(s):  
Older Adults ◽  
Medical Model ◽  
Recovery Process ◽  
Swallowing Disorders ◽  
Current Evidence ◽  
Care Needs ◽  
Skilled Nursing ◽  
Person Centered Care ◽  
Centered Care ◽  
Traditional Medical Model

Purpose Person-centered care shifts the focus of treatment away from the traditional medical model and moves toward personal choice and autonomy for people receiving health services. Older adults remain a priority for person-centered care because they are more likely to have complex care needs than younger individuals. Even more specifically, the assessment and treatment of swallowing disorders are often thought of in terms of setting-specific (i.e., acute care, skilled nursing, home health, etc.), but the management of dysphagia in older adults should be considered as a continuum of care from the intensive care unit to the outpatient multidisciplinary clinic. In order to establish a framework for the management of swallowing in older adults, clinicians must work collaboratively with a multidisciplinary team using current evidence to guide clinical practice. Private practitioners must think critically not only about the interplay between the components of the evidence-based practice treatment triad but also about the broader impact of dysphagia on caregivers and families. The physical health and quality of life of both the caregiver and the person receiving care are interdependent. Conclusion Effective treatment includes consideration of not only the patient but also others, as caregivers play an important role in the recovery process of the patient with swallowing disorders.

scholarly journals Perceptions of Spirituality and Spiritual Care of Health Professionals Working in a State Hospital

Religions ◽  
2018 ◽  
Vol 9 (10) ◽  
pp. 312
Author(s):  
Kerem Toker ◽  
Fadime Çınar
Keyword(s):  
State Hospital ◽  
Spiritual Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Recovery Process ◽  
Spiritual Needs ◽  
Care Needs ◽  
Scale Scores ◽  
Specific Care ◽  
The Individual

Background: The determination and fulfillment of the spiritual needs of the individual in times of crisis can be realized by the health care professionals having the knowledge and skills to provide individual-specific care. This research was conducted to determine the perceptions of health professionals about spirituality and spiritual care. Methods: The study of 197 health professionals working in a state hospital was performed. This study is a descriptive study which was conducted between December 2017 and January 2018. Data in the form of an “Introductory Information Form” and “Spirituality and Spiritual Care Grading Scale” was collected. In the analysis of the data, the Mann–Whitney U test, Kruskal–Wallis tests, frequency as percentage, and scale scores as mean and standard deviation were used. Results: It was determined that 45.7% of the health professionals were trained in spiritual care, but that they were unable to meet their patients’ spiritual care needs due to the intensive work environment and personnel insufficiency. The total score averaged by the health professionals on the spirituality and spiritual care grading scales was 52.13 ± 10.13. Conclusions: The findings of the research show that health professionals are inadequate in spiritual care initiatives and that their knowledge levels are not at the desired level. With in-service trainings and efforts to address these deficiencies, spiritual care initiatives can be made part of the recovery process.

Increasing Successful Vocational Rehabilitation Outcomes for Individuals with Substance Use Disorders

2018 ◽  
Vol 49 (1) ◽  
pp. 4-10
Author(s):  
Stephanie L. Lusk ◽  
Frances R. B. Veale
Keyword(s):  
Substance Use ◽  
Vocational Rehabilitation ◽  
Substance Use Disorders ◽  
Job Search ◽  
Recovery Process ◽  
Vital Role ◽  
Chi Square ◽  
Gainful Employment ◽  
Rehabilitation Outcomes ◽  
Case Closure

Employment is essential during the treatment and recovery process for individuals with substance use disorders. As such, rehabilitation counselors play a vital role in ensuring the success of these consumers by offering services that increase the likelihood of employment. State and federal vocational rehabilitation programs can offer any of 19 services to consumers and by identifying services offered to those with substance use disorders who have been rehabilitated successfully, counselors can make a concerted effort to incorporate them when most appropriate. As a replica of a study conducted over 10 years ago, the current study seeks to determine if the services identified as increasing successful employment outcomes using data from 2005 still hold true today especially since gainful employment remain low for this population. After effective services are identified, one may then determine how to best incorporate these services into the overall Individual Plan for Employment (IPE) to better assist those with substance use disorders (SUDs). Rehabilitation Services Administration (RSA) 911 datasets were analyzed for years 2010-2014, and chi-square analyses identified five services as increasing the probability of successful case closure (i.e., employment): 1) job placement, 2) on-the-job supports, 3) maintenance, 4) job search, and 5) other. Descriptions of each service are provided as well as suggestions for application and implementation.

scholarly journals Living with MND: An evaluation of care pathways available to adults with, and the families or carers of, adults with Motor Neurone Disease in Scotland

2021 ◽  
Author(s):  
Jo Ferrie ◽  
Phillippa Wiseman ◽  
Nick Watson
Keyword(s):  
Social Care ◽  
Informed Choice ◽  
Vital Role ◽  
Motor Neurone ◽  
The Body ◽  
Motor Neurone Disease ◽  
Specialist Care ◽  
Care Needs ◽  
Care And Support ◽  
General Wards

Main Findings Motor Neurone Disease (MND) is a progressive condition that damages motor neurones, the cells that control voluntary muscle activity, in both the spinal cord and the brain. It can cause difficulty in walking and movement, talking, swallowing and breathing and many muscles in the body can become affected. To find out what it is like to live with MND from the perspective of those with the condition we carried out a longitudinal study in which we interviewed 40 people with MND and their partners a number of times over a two year period. We found that:•Control, or more particularly the lack of it was the overarching theme that occurred throughout the interviews. People wanted to be consulted, informed and involved in decisions about their health and their social care and where this happened people were more likely to report satisfaction with the service. •The diagnosis of MND is a long and protracted process, one that was for many a very distressing experience. 45% of those we spoke to took over 12 months for a diagnosis, 19% over 18 months. Participants had difficulty getting professionals to take their symptoms seriously and once they entered the neurology system many people experienced delays and often the diagnosis was not confirmed by a neurologist. •Physical access to hospitals was in some cases difficult. Car parking and the location of the clinic often made it hard for people to get to a hospital appointment.•Health professionals had an important role. Good professionals were those who took time to create a sense of teamwork with the person with MND and their family. This was less likely to happen with hospital consultants and where this did not people felt insecure and not listened to. There was also some evidence of poor communication between professionals and medical notes were often not shared between different professionals. Where people accessed general wards they were rarely treated well.•Informal carers provided much of the social care and support for those with MND, with spouses meeting most of the need. Whilst many people were happy with this arrangement meeting the need placed a great deal of strain on the families. Many people did not want to rely on care supplied by outside agencies as they did not trust the quality or the reliability of the care and neither did they want their home overrun with people.•Housing adaptations and the provision of aids to daily living were for many a great cause of stress and strain and many people felt that they were not involved in the decision making process, felt out of control and unable to influence the situation. The rapidly progressive nature of MND can exacerbate this problem. •Social Care and support provided by local authorities was very heavily criticised There were inconsistencies between services, people felt excluded from decisions made about their care and their care needs and people did not have access to the necessary information to make an informed choice about which services to access.•Specialist Care Nurses (SCN) played a vital role in the care and support of those with MND. Not only do they provide help and support directly they also help to act as a champion for the family and coordinate services and service provision. This service is however under great strain and there are a significant number of people for whom this service is not working because the service was too stretched and the resources were not available to allow the SCN to meet their needs.

Pancreatic Disorders in the Newborn

2000 ◽  
Vol 19 (4) ◽  
pp. 13-20 ◽  
Author(s):  
Laura McKenna
Keyword(s):  
Nursing Care ◽  
Nurse Practitioners ◽  
Neonatal Diabetes ◽  
Diabetic Mother ◽  
Endocrine Disorders ◽  
Care Needs ◽  
Skilled Nursing ◽  
Mortality And Morbidity ◽  
Pancreatic Dysfunction ◽  
Pancreatic Disorders

Except for the hyperinsulinism associated with the infant of a diabetic mother (accounting for about 5 percent of NICU admissions annually), pancreatic disorders of the newborn are rare. Congenital anomalies (such as annular pancreas) and endocrine disorders (such as hyperinsulinism of nesidioblastosis or hyperglycemia of neonatal diabetes mellitus) present many challenges to the personnel caring for these infants and their families. The potential mortality and morbidity of these disorders make it imperative for nurses and nurse practitioners working with infants to recognize and understand pancreatic dysfunction so that appropriate and timely intervention can prevent complications of brain injury and developmental delay. The home care needs of these infants and the extensive teaching needs of their parents require skilled nursing care to ensure a safe discharge.

Associations between clinical indicators of quality and aged-care residents’ needs and consumer and staff satisfaction: the first Australian study

2019 ◽  
Vol 43 (2) ◽  
pp. 133 ◽  
Author(s):  
Yun-Hee Jeon ◽  
Anne-Nicole Casey ◽  
Kha Vo ◽  
Kris Rogers ◽  
Belinda Poole ◽  
...  
Keyword(s):  
Weight Loss ◽  
Care Home ◽  
Physical Restraint ◽  
Aged Care ◽  
Care Quality ◽  
Staff Satisfaction ◽  
Australian Study ◽  
Care Needs ◽  
Clinical Indicators ◽  
Pressure Injury

Objectives To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 – 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents’ level of care needs. Conclusions This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents’ care needs. What is known about the topic? Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents’ clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited. What does this paper add? This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes. What are the implications for practitioners? Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have.

scholarly journals Cause for concerns: gender inequality in experiencing the COVID-19 lockdown in Germany

2020 ◽  
Author(s):  
Christian S. Czymara ◽  
Alexander Langenkamp ◽  
Tomas Cano
Keyword(s):  
Gender Inequality ◽  
Wage Gap ◽  
Recovery Process ◽  
Paid Work ◽  
Care Needs ◽  
Social Contacts ◽  
Personal Experiences ◽  
Physical Level ◽  
Tremendous Impact ◽  
Shed Light

COVID-19 is having a tremendous impact on gender relations, as care needs have been magnified due to schools and day-care closures. Using topic modeling on over 1,100 open reports from a survey fielded during the first four weeks of the lockdown in Germany, we shed light on how personal experiences of the lockdown differ between women and men. Our results show that, in general, people were most concerned about social contacts and childcare. However, we find clear differences among genders: women worried more about childcare while men were more concerned about paid work and the economy. We argue that the COVID-19 pandemic is affecting women more heavily than men not only at the physical level of work (e.g. women are reducing more paid work hours than men), but also through increasing the division regarding the cognitive level of work (e.g. women are more worried about childcare work while men are about paid work). These developments can potentially contribute to a future widening of the gender wage gap during the recovery process.

Physiotherapy in palliative care

2015 ◽  
Author(s):  
Anne M. English
Keyword(s):  
Palliative Care ◽  
Malignant Disease ◽  
Interdisciplinary Team ◽  
Vital Role ◽  
Valuable Contribution ◽  
Care Needs ◽  
Good Communication ◽  
Patient Pathway ◽  
Palliative Care Needs

This chapter gives an overview of the role of the physiotherapist and some of the conditions they assess and treat. Physiotherapy in the field of oncology and palliative care is a continuously evolving and developing speciality in cancer and other non-malignant disease. Patients with palliative care needs often present with multifaceted problems associated with an increasing range of underlying pathologies. The physiotherapist is involved in the treatment of patients with active and progressive conditions some of which include cancer, neurological, cardiac, respiratory, musculoskeletal conditions, and lymphoedema. Rehabilitation is now considered a crucial aspect of the patient pathway in which the physiotherapist plays a vital role. Assessment and good communication skills are an essential component when managing challenging and complex problems. This chapter demonstrates the physiotherapist’s valuable contribution to the interdisciplinary team and the importance of the role within palliative care.

scholarly journals Design and Optimization of a Process for the Production of Methyl Methacrylate via Direct Methylation

Processes ◽  
2019 ◽  
Vol 7 (6) ◽  
pp. 377 ◽  
Author(s):  
Taotao Liang ◽  
Xiaogang Guo ◽  
Abdulmoseen Segun Giwa ◽  
Jianwei Shi ◽  
Yujin Li ◽  
...  
Keyword(s):  
Methyl Methacrylate ◽  
Recovery Process ◽  
Double Effect ◽  
Vital Role ◽  
Green Process ◽  
Stage Number ◽  
Broad Application ◽  
Design And Optimization ◽  
Heat Exchange Network ◽  
Exchange Network

Methyl methacrylate (MMA) plays a vital role in national productions with broad application. Herein, the production of MMA is realized by the improved eco-friendly direct methylation method using Aspen Plus software. Three novel kinds of energy-saving measures were proposed in this study, including the recycle streams of an aqueous solution, methacrolein (MAL), and methanol, the deployment of double-effect distillation instead of a normal one, and the design of a promising heat-exchange network. Moreover, MMA with a purity of 99.9% is obtained via the design of a MAL absorber column with an optimal stage number of 11 and a facile chloroform recovery process by using the RadFrac model. Thus, the proposed green process with energy-conservation superiority is the vital clue for developing MMA, and provides a reference for the production of MMA-ramifications with excellent prospects.

scholarly journals Continence Status and Presence of Pressure Skin Injury among Special Elderly Nursing Home Residents in Japan: A Nationwide Cross-Sectional Survey

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 34
Author(s):  
Motofumi Suzuki ◽  
Megumi Kodaira ◽  
Keiko Suyama ◽  
Taro Murata ◽  
Haruki Kume
Keyword(s):  
Risk Factors ◽  
Nursing Homes ◽  
Fecal Incontinence ◽  
Significant Risk ◽  
Care Needs ◽  
Cross Sectional ◽  
Double Incontinence ◽  
Pressure Injury ◽  
Continence Status ◽  
Skin Pressure

Urinary and fecal incontinence as well as skin pressure injury are common healthcare problems in nursing homes; however, the prevalence and related risk factors were not well understood in the Japanese special elderly nursing home settings. We surveyed the prevalence of urinary, fecal and double incontinence, and skin pressure injury among the elderly living in special elderly nursing homes in Japan. A nationwide cross-sectional epidemiological survey was conducted with a total of 4881 residents. The prevalence of urinary, fecal and double incontinence was 82.9%, 68.9% and 64.9%, respectively. Skin pressure injury was found in 283 residents (283/4881, 5.8%). Age, Care-Needs level, loss of voiding desire, and fecal incontinence were significant risk factors for urinary incontinence. Residential period, Care-Needs level, loss of voiding and defecation desires, and urinary incontinence were significant risk factors for fecal incontinence. Only male sex was a significant risk factor for skin pressure injury. Our study revealed continence status and the prevalence of pressure skin injury among older adult residents who receive end-of-life care in special elderly nursing homes in Japan. Further studies should be conducted to examine whether recovery of urinary and fecal sensations improves continence status.

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