[Medical Rehabilitation by General Practitioners in Patients With Chronic Mental Disorders.]
[Medical Rehabilitation by General Practitioners in Patients with Chronic Mental Disorders.]
Filed under: Rehab Centers
Rehabilitation (Stuttg). 2012 Dec 11;
Muschalla B, Keßler U, Schwantes U, Linden M
Rehabilitation medicine is the medical specialty for the prevention, diagnosis and treatment of chronic disorders. This is especially relevant in mental disorders. Treatment of chronic disorders requires a complex and multidisciplinary long-term-treatment which is regularly done by general practitioners. However, concepts for rehabilitation-medicine in outpatient settings are until now by and large insufficient.40 general practitioners were asked to give an estimate on how many patients with chronic psychological disorders were among their patients.Next, 1?451 patients between 18 and 60 years filled in the WHO-5 wellbeing-rating, the IMET scale on participation disorders, the Burvill scale on multimorbidity and answered questions on their mental and work status.The general practitioners estimated that on average 41,9% (SD=18,2; Range 15-90%) were suffering from chronic mental disorders. 46,5% of the patients said that they suffered from mental problems, 38,3% had mental problems longer than 6 months, i.?e., chronic, and in 26,9% even persistent. 29,7% of the patients suffered from chronic mental problems with relevant participation disorders.Patients with chronic mental disorders and participation problems are frequent in general practice. Rehabilitation medicine is an important part the daily activities of general practitioners, including diagnosis, treatment, treatment coordination, and sociomedical interventions like sick leave certificates, or initiating inpatient rehabilitation. General practitioners should get more scientific attention when concepts of rehabilitation are discussed.
HubMed – rehab
[The Development of Practice Guidelines for Psychological Interventions in the Rehabilitation of Patients with Coronary Heart Disease: Methods and Results.]
Filed under: Rehab Centers
Rehabilitation (Stuttg). 2012 Dec 11;
Mittag O, Reese C
Available guidelines and treatment standards are not sufficiently detailed to give practical guidance for psychological interventions in the rehabilitation of patients with coronary heart disease. We therefore aimed at developing evidence- and consensus-based practice guidelines for psychological interventions in the rehabilitation of individual patients with coronary heart disease. The following steps were taken: (1) A systematic search for guidelines and reviews, and a survey of rehabilitation centres concerning present structures and the practice of psychological services, (2) development of a first draft of the practice guidelines in an expert workshop, (3) a survey of all senior psychologists and chief physicians of the rehab centres for their approval, as well as focus groups with rehab patients, and (4) revision of the recommendations and final consensus development in an expert workshop. Significant aspects of the guidelines that go beyond present practice are routine screening for psychological comorbidity, neuropsychological screening for cognitive dysfunction in particular patients, and employment of defined psychologically grounded interventions by the entire rehab team. So far, the practice guidelines have been widely accepted by professionals in the field of rehabilitation.
HubMed – rehab
[Acceptance and Practicability of Evidence-Based Therapy Standards in Child and Adolescent Rehabilitation: Results of a User Survey.]
Filed under: Rehab Centers
Rehabilitation (Stuttg). 2012 Dec 11;
Ahnert J, Löffler S, Winnefeld M, Vogel H
The introduction of evidence-based therapy standards in child and adolescent rehabilitation of the German statutory pension insurance scheme (Deutsche Rentenversicherung Bund, 2011) was accompanied by a user survey that gave the participating rehabilitation centres the opportunity to comment on the new therapy standards and to suggest modifications.The survey questionnaire encompassed various topics related to the therapy standards, amongst them quality, comprehensibility, and acceptance, evaluation of feedback, and reasons for noncompliance with therapy standard requirements. For each of the 3 indications, a separate questionnaire was applied to assess modification suggestions regarding KTL therapy elements, the minimum percentage of patients to be treated accordingly, and the minimum duration of therapeutic procedures for each evidence-based treatment module. Responses from 14 rehab centres (return rate 54%) were obtained and analyzed.According to the majority of the responding rehabilitation centres, the therapy standards for child and adolescent rehabilitation fulfilled the quality features of topicality, multidisciplinarity, and relevance for routine rehabilitative practice. The degree of empirical grounding was evaluated more inconsistently. Difficulties with coding of KTL therapy elements were cited as the primary reasons for failing to comply with requirements in 2008.Exemplarily, the results of the user survey regarding the rehabilitative treatment of children and adolescents with obesity (age group: 8 years and older) are presented in detail.Concluding, the modifications to the therapy standards in child and adolescent rehabilitation introduced on the basis of the user survey are set out.
HubMed – rehab
Use of early indicators in rehabilitation process to predict one-year mortality in elderly hip fracture patients.
Filed under: Rehab Centers
Hip Int. 2012 Dec 4; 0
Dubljanin-Raspopovic E, Markovic Denic L, Marinkovic J, Grajic M, Tomanovic Vujadinovic S, Bumbaširevic M
Hip fractures remain one of the most devastating injuries in the elderly. Early prediction of outcome following hip fracture potentially results in more efficient health care. The aims of this study were to explore predictors of ambulation status at hospital discharge in patients ?65 years of age operated on for fracture of the hip, and to investigate the impact of ambulation status at hospital discharge on 1-year mortality after hip fracture. We studied 344 patients who underwent surgery for hip fracture during a 12 month period. Multivariate regression analysis was used to explore predictive factors for ambulatory status at discharge, and 1-year mortality adjusted on important baseline variables. Cumulative 1-year mortality was significantly lower for patients in the ambulatory group when compared to patients in the non-ambulatory group. Patients who were older, had severe cognitive impairment, lower functional level before injury, and in whom postoperative delirium and pressure ulcers occurred had a higher chance of not recovering their gait ability at hospital discharge, and being dead 1 year after hip fracture. Inability to walk at hospital discharge and presence of delirium are independent predictors of 1-year mortality. Every effort should be made to assure early mobilisation after hip fracture surgery, and prevention, prompt recognition and treatment of postoperative complications is important in order to facilitate better short-and long-term outcome.
HubMed – rehab
Seizures and epilepsy in elderly patients of an urban area of Iran: clinical manifestation, differential diagnosis, etiology, and epilepsy subtypes.
Filed under: Rehab Centers
Neurol Sci. 2012 Dec 12;
Tabatabaei SS, Delbari A, Salman-Roghani R, Shahgholi L, Fadayevatan R, Mokhber N, Lokk J
The incidences of seizures and epilepsy in the population show a peak after 60 years of age. Due to the lack of reported clinical aspects of seizure and epilepsy in the older patients in our region in Iran, this study was conducted to describe the clinical manifestation, etiology, differential diagnosis, and epilepsy subtypes of epilepsy and seizure. A cross-sectional retrospective study was performed on all consecutively elderly seizure and epilepsy patients, referred to the Epilepsy Association in the city of Qom, Iran over a 10-year period. A total of 466 patients aged >60 years were admitted. 31 % of the patients had epilepsy or seizure and 69 % of them had non-epileptic events. The most prevalent differential diagnoses in the beginning were syncope and cardiovascular disorders. The most frequent clinical symptom of epilepsy was generalized tonic-clonic seizures (75 %). The most common cause of seizure was systemic metabolic disorder (27 %). In epileptic elderly patients, no cause was ascertained for 38 % and the most frequently observed pathological factors were cerebrovascular diseases, which accounted for 24 %. The most common type of epileptic seizure was generalized epileptic seizures (75 %). 10 % of elderly epileptic patients suffered from status epilepticus, which was primarily caused by anoxia. Despite the rising rate and potentially profound physical and psychosocial effects of seizures and epilepsy, these disorders have received surprisingly little research focus and attention in Iran. Referring older patients to a specialist or a specialist epilepsy center allows speedy assessment, appropriate investigation and treatment, and less likely to miss the diagnosis.
HubMed – rehab
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