Postural Disharmony in Relation to the Back Pain and Physiotherapeutic Rehabilitation.

Postural disharmony in relation to the back pain and physiotherapeutic rehabilitation.

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Acta Inform Med. 2012 Jun; 20(2): 103-5
Hundozi-Hysenaj H, Hysenaj V, Hysenaj V, Shalaj I

Postural attitude is putting the body at attention as an important factor in the prevention of spinal deformities axis and thus the back pains due to changes in articulacio sacroiliaca (ASI), lumbal syndrome (SL), cervical syndrome (SC) and others.The purpose of this research is to determine the level of impact of spinal muscular misbalance that affects daily life activities, physiotherapeutic protocol according to Dr. MC Gill’s, and senso-motoric exercises to reduce the pain that backpack. In this material were included 43 patients, 13 males and 30 females aged 18 to 50 years old who were inculded in the second and third degree after completing a survey of ODI’s-the index of disability (Oswestry Disability Index).The results obtained show that after the protocol of physiotherapeutic Dr. MC Gill’s, and senzoro-motor exercise significantly decrease pain in the back which confirmed the results of the questionnaire according to ODI, where it is seen that out of 30 patients with complaints of second-degree or 69.8%, and 13 patients or 30.2% that have been complaints of third degree with significant disorders of activity of daily life before rehabilitation treatment. The results obtained after three-month rehabilitation treatment according ODIT’s questionnaire (Oswestry Disability Index) show that 31 patients have complaints of first instance or 72.1%, then 9 patients have complaints or 20.9% of second level and 3 patients or 7.0% remained in the third degree of apparent disorder of daily life activity.From this we can highlight the misbalance of muscles of the body is one of the leading causes of back pain.
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A Lean Six Sigma Quality Improvement Project to Increase Discharge Paperwork Completeness for Admission to a Comprehensive Integrated Inpatient Rehabilitation Program.

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Am J Med Qual. 2013 Jan 15;
Neufeld NJ, Hoyer EH, Cabahug P, González-Fernández M, Mehta M, Walker NC, Powers RL, Mayer RS

Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.
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‘Best practice’ in developing and evaluating palliative and end-of-life care services: A meta-synthesis of research methods for the MORECare project.

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Palliat Med. 2013 Jan 15;
Evans CJ, Harding R, Higginson IJ,

Background:Improved and cost-effective palliative and end-of-life care is an international policy imperative. Developments are impeded by a weak and often inconsistent evidence base.Aim:To examine the main methodological challenges and limitations to developing and evaluating palliative and end-of-life care services and requirements to further this field of research.Design:A meta-synthesis to systematically appraise the evidence from systematic reviews on the research methods used in studies evaluating the effectiveness of palliative care services for patients with advanced illness and/or carers meeting inclusion and quality criteria. We extracted data from the reviews on the methodological issues reported on the included studies into Excel spreadsheets and generated textual descriptions coded and analysed in NVivo.Data sources:Six electronic databases, reference chaining and expert advice.Results:In total, 27 systematic reviews were included on the effectiveness of palliative care services for patients with cancer (n = 6), advanced illness (n = 10) or mixed populations (n = 11) across care settings. Main methodological challenges were implementation as a continuum, active precise recruitment, addressing randomisation and economic evaluation beyond cost savings.Conclusions:The complexity of delivering and evaluating palliative and end-of-life care services requires the accumulation of knowledge from multiple sources to understand the active components of an intervention to deliver patient benefit and examine the evaluation methods to detect change and reveal processes prior to a definitive trial. The implementation of evidence into practice should form a continuum throughout the evaluation stages to reveal understanding on the process of intervention delivery, the context and the intended outcome(s).
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Counting the Cost of Meningococcal Disease : Scenarios of Severe Meningitis and Septicemia.

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Paediatr Drugs. 2013 Jan 16;
Wright C, Wordsworth R, Glennie L

BACKGROUND: Meningococcal disease can result in severe disabling sequelae, but there is no published information about the lifelong rehabilitation costs of patients with severe outcome in the UK. As cost-effectiveness studies play a crucial role in determining whether immunization programmes will be implemented, it is important to identify these costs. OBJECTIVE: The aim of the study was to estimate lifelong rehabilitation costs associated with severe cases of meningococcal disease and to present these costs in a format appropriate for use in a cost-effectiveness analysis. METHODS: Two severe scenarios of meningococcal disease with major sequelae were developed; one that presented acutely as meningitis and the other as septicemia. Scenarios were based on systematic reviews of the literature describing the sequelae of meningococcal disease, dialogue with Meningitis Research Foundation members who have experience of the disease, and discussions with pediatricians who have been responsible for managing children with this disease over many years. The two scenarios were devised to represent cases typical of the severe end of the spectrum. To obtain a comprehensive list of the health, educational and other resources used by survivors during and since their acute illness, families of individuals with sequelae similar to those in each of our scenarios were interviewed. Relevant academics and professionals in health, social care and education were consulted in order to ensure that our scenarios accurately represented the treatment and support that individuals with such sequelae might realistically receive from the National Health Service (NHS), the local authority and Personal Social Services (PSS). The majority of costs were derived from English Department of Health reference costs and unit costs of health and social care reflecting values for the financial year 2008-2009 indexed to 2010-2011. Costs were based on a life expectancy of 70 years in each scenario and are presented at a discount rate of 3.5 % for the first 30 years and 3 % thereafter, as recommended by the UK treasury (non-discounted costs are also presented for comparison). Costs are presented from both an NHS/PSS perspective and a government perspective. RESULTS: This study has revealed that severe cases of disease that result in long-term sequelae can result in costs to the NHS/PSS of around £160,000-£200,000 in the first year alone. Over a lifetime of 70 years, discounted costs from an NHS/PSS perspective ranged from approximately £590,000 to £1,090,000 (£1,250,000-£3,320,000 undiscounted) and discounted costs from a government perspective ranged from £1,360,000 to £1,720,000 (£3,030,000-£4,470,000 undiscounted). CONCLUSION: This study fills a gap in the UK literature and produces estimates that can be used in cost-effectiveness analysis to better represent the cost of illness at the severe end of the spectrum. Costs from a government perspective highlight the wider impacts of this disease, which is important for clinical decision makers, and budgetary and service planners to be aware of when making decisions about the benefits of implementing public health interventions such as immunization programmes.
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