Medical Complications and Outcomes at an Onsite Rehabilitation Unit for Older People.

Medical complications and outcomes at an onsite rehabilitation unit for older people.

Ir J Med Sci. 2013 Mar 1;
Mulroy M, O’Keeffe L, Byrne D, Coakley D, Casey M, Walsh B, Harbison J, Cunningham C

BACKGROUND: The rehabilitation of older patients in Ireland after an acute medical event occurs at dedicated onsite hospital units or at offsite centres. Information on medical complications and outcomes is inadequate. AIMS: Enumeration of medical complications of patients admitted to a dedicated onsite rehabilitation unit for older people, and the extent of co-morbidity in the population with the effects that this had on the evolution of medical complications. METHODS: A retrospective analysis of patients admitted to a 58-bed onsite unit over a 1-year period was performed. Information collating co-morbidities, medical complications and functional outcomes was recorded. RESULTS: Medical complications occurred in almost 95 % of patients, where full data were available. Over one-third required intravenous therapy. CONCLUSION: Twenty-four hour medical cover is required for older patients managed at onsite rehabilitation units. Further studies on offsite medical rehabilitation facilities for older patients are required. HubMed – rehab


Comparative Analysis of Inter- and Intraligamentous Distribution of Sensory Nerve Endings in Ankle Ligaments: A Cadaver Study.

Foot Ankle Int. 2013 Mar 1;
Rein S, Hanisch U, Zwipp H, Fieguth A, Lwowski S, Hagert E

BACKGROUND: The aim of this study was to analyze the inter-, intraligamentous, and side-related patterns of sensory nerve endings in ankle ligaments. METHODS: A total of 140 ligaments from 10 cadaver feet were harvested. Lateral: calcaneofibular, anterior-, posterior talofibular; sinus tarsi: lateral- (IERL), intermediate-, medial-roots inferior extensor retinaculum, talocalcaneal oblique and canalis tarsi (CTL); medial: tibionavicular (TNL), tibiocalcaneal (TCL), superficial tibiotalar, anterior/posterior tibiotalar portions; syndesmosis: anterior tibiofibular. Following immunohistochemical staining, the innervation and vascularity was analyzed between ligaments of each anatomical complex, left/right feet, and within the 5 levels of each ligament. RESULTS: Significantly more free nerve endings were seen in all ligaments as compared to Ruffini, Pacini, Golgi-like, and unclassifiable corpuscles (P ? .005). The IERL had significantly more free nerve endings and blood vessels than the CTL (P ? .001). No significant differences were seen in the side-related distribution, except for Ruffini endings in right TCL (P = .016) and unclassifiable corpuscles in left TNL (P = .008). The intraligamentous analysis in general revealed no significant differences in mechanoreceptor distribution. CONCLUSIONS: The IERL at the entrance of the sinus tarsi contained more free nerve endings and blood vessels, as compared to the deeper situated CTL. Despite different biomechanical functions in the medial and lateral ligaments, the interligamentous distribution of sensory nerve endings was equal. CLINICAL RELEVANCE: The intrinsic innervation patterns of the ankle ligaments provides an understanding of their innate healing capacities following injury as well as the proprioception properties in postoperative rehabilitation. HubMed – rehab


Providing Culturally Competent Care in Home Infusion Nursing.

J Infus Nurs. 2013 Mar; 36(2): 108-114
Petroulias P, Groesbeck L, Wilson FL

All health care providers, and particularly nurses who are on the front lines of patient care, must be skilled in providing culturally appropriate and competent care. Cultural competence needs to be guided by a philosophical framework. This article was written to describe cultural care in the context of home infusion nursing using the Process of Cultural Competence in the Delivery of Healthcare Services model. The model is used to provide structural reference in order to offer nursing care to members of diverse cultures. The 5-part model gives an overarching conceptual orientation to assist the nurse in providing quality care that is culturally sensitive. HubMed – rehab


A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge services after stroke.

Clin Rehabil. 2013 Mar 1;
Cobley CS, Fisher RJ, Chouliara N, Kerr M, Walker MF

Objective:To investigate patients’ and carers’ experiences of Early Supported Discharge services and inform future Early Supported Discharge service development and provision.Design and subjects:Semi-structured interviews were completed with 27 stroke patients and 15 carers in the Nottinghamshire region who met evidence-based Early Supported Discharge service eligibility criteria. Participants were either receiving Early Supported Discharge or conventional services.Setting:Community stroke services in Nottinghamshire, UK.Results:A thematic analysis process was applied to identify similarities and differences across datasets. Themes specific to participants receiving Early Supported Discharge services were: the home-based form of rehabilitation; speed of response; intensity and duration of therapy; respite time for the carer; rehabilitation exercises and provision of technical equipment; disjointed transition between Early Supported Discharge and ongoing rehabilitation services. Participants receiving Early Supported Discharge or conventional community services experienced difficulties related to: limited support in dealing with carer strain; lack of education and training of carers; inadequate provision and delivery of stroke-related information; disjointed transition between Early Supported Discharge and ongoing rehabilitation services.Conclusions:Accelerated hospital discharge and home-based rehabilitation was perceived positively by service users. The study findings highlight the need for Early Supported Discharge teams to address information and support needs of patients and carers and to monitor their impact on carers in addition to patients, using robust outcome measures. HubMed – rehab