Patient Outcomes Using Revised Guidance NHS Continuing Care Eligibility Criteria, Scotland (CEL 2008).

Patient outcomes using revised guidance NHS Continuing Care Eligibility Criteria, Scotland (CEL 2008).

Scott Med J. 2013 Feb; 58(1): 16-19
Martin B, Valiyaparambath N, Gray J

Aim To determine the efficacy of selection of patients for NHS (Scotland) continuing care using revised guidance eligibility criteria, CEL (2008). Methods On September 2009, a census was conducted of 632 patients, distributed over 10 hospital sites in NHS Lanarkshire Older People’s Directorate, to identify those patients who had future care needs assessed using revised NHSS CEL (2008) eligibility criteria during the previous 3 months. These patients were then assigned to one of four categories: (1) eligible for NHS continuing care; (2) likely destination care home; (3) likely discharge home with complex care package; and (4) outcome uncertain. ‘Frailty’ was recorded in a sub-group of patients using Rockwood’s frailty index. The index records frailty on a scale 0-1, a higher score indicating greater frailty. Outcomes were recorded at 2-monthly intervals for 1 year. Patients undergoing acute assessment and/or specialist rehabilitation, those admitted before 1 April 2009 and already accepted for NHS continuing care and those with a planned discharge date were excluded. Results Two hundred and eleven patients were identified as meeting the criteria for allocation to one of the four categories. Mortality at 1 year was as follows: NHS continuing care 40/45 (89%), likely Care Home destination 39/81 (48%), likely home discharge 22/61 (35%), outcome uncertain 13/24 (54%). Mean frailty scores were: NHS continuing care 0.4, likely care home 0.34, likely discharge home 0.29; p=0.0002 (ANOVA). Re-admission rates were high, 60% once and 40% twice or more, in patients discharged from hospital. Conclusion The revised guidance on Eligibility for NHS Continuing Care in Scotland, CEL (2008), is useful in identifying the frailest patients with complex needs and limited survival. However, hospital re-admission rates and mortality are high in all patients considered for eligibility to NHS continuing care in whom the guidance is applied. HubMed – rehab


Evaluation of erectile dysfunction in permanent pacemaker implanted patients with cardiac rhythm disorder prediagnosis.

Scott Med J. 2013 Feb; 58(1): 7-11
Sagnak L, Ersoy H, Karakoyunlu N, Murat S, Ozok U, Topaloglu H, Ozturk U, Akdemir R

Background and aims To evaluate the anxiety, depression and related psychogenic erectile dysfunction that might be developed before and after pacemaker implantation in patients with cardiac arrhythmias. Material and methods Thirty permanent pacemaker implanted male patients, were enrolled to study between September 2006 and September 2008. Erectile function domain questions of International Index of Erectile Function (IIEF-6) and Hospital Anxiety and Depression Scale (HAD) questionnaires were applied to patients, 6 months before pacemaker implantation (BP6) and on month 1 (AP1) and 6 after application (AP6). Patients were included in a multidisciplinary cardiac rehabilitation-adaptation program with a duration of 1-2 months. Patients were evaluated in subgroups. Results Mean age was 51.5?±?10.3. Most frequent diagnosis was observed as AV block in etiology. The mean IIEF values were changed 22.8?20.2?24.6 in BP6, AP1 and AP6 time frames consecutively. However, the mean HAD-Anxiety scores were evaluated as 8.1?17.0?7.3 and the mean HAD-Depression as 3.9?7.9?8.9 consecutively in the same time frames. Conclusion Cardiac arrhythmia plus permanent pacemaker implantation, increased anxiety and depression of patients and decreased erectile function at AP1; however, the improvement in cardiac symptoms at AP6 with the possible positive effects of rehabilitation program, helps to reduce anxiety and increased IIEF scores, although there was still a slight increase in depression levels. HubMed – rehab


Pulmonary rehabilitation after total laryngectomy: a randomized cross-over clinical trial comparing two different heat and moisture exchangers (HMEs).

Eur Arch Otorhinolaryngol. 2013 Apr 18;
Herranz J, Espiño MA, Morado CO

Post-laryngectomy heat and moisture exchanger (HME) use is known to have a beneficial effect on tracheal climate, pulmonary symptoms and related aspects. This study aims to investigate differences in clinical effects between the first and second generation Provox HMEs. The second generation (Provox XtraHME) has better humidification properties than the first generation (Provox HME), and has been shown to further improve tracheal climate. Forty-five laryngectomized patients, who were already using an HME, participated in a prospective, randomized cross-over clinical study in which each HME was used for 6 weeks. Results showed that for most parameters studied, the second generation HME performed equally well or better than the first generation HME. The improvement in tracheal climate translated into patients reporting significantly less tracheal dryness with the second generation than with the first generation (p = 0.039). Using an HME with better humidification properties is related to a reduction in tracheal dryness in our study population. HubMed – rehab


A brief cookery skills intervention is no more effective than written information alone in reducing body mass index in overweight cardiac rehabilitation patients.

Health Promot Int. 2013 Apr 17;
McGorrian C, O’ Hara MC, Reid V, Minogue M, Fitzpatrick P, Kelleher C

Overweight and obesity are common health risks, but it can be difficult to effect weight change. This randomized controlled trial examined the effects of a novel Cookery skills intervention on body mass index (BMI) in overweight and obese patients with cardiovascular disease, who had previously attended a cardiac rehabilitation programme. Patients with BMI >27 kg/m(2) were randomized to either a 5-week cookery skills course with written educational materials, or to written materials only. Questionnaires on lifestyle risk factors and food frequencies were administered at baseline, 6 and 24 months. The primary outcome in an intention-to-treat analysis was a change in BMI at 6 months. Secondary outcome was a change in BMI at 24 months. Changes in macronutrient consumption were examined in both analysis of covariance and repeated measures ANOVA models. Of the 172 patients, 116 (67.4%) patients consented to participate in the study. The intervention was found to be well accepted and attended by the patients (70.5% of patients in the intervention group attended the sessions). Whilst both intervention and control groups were noted to have a small reduction in BMI, there was no significant difference between the groups. There was no significant group effect noted for any change in macronutrient consumption at 6- or 24-month follow-up. This pilot study of a novel cookery skills project was well accepted amongst this population. Although the majority of participants had a net loss in BMI, the cookery skills intervention was not associated with any change in BMI beyond that achieved by written information alone. HubMed – rehab