Risk of Orthopedic Surgical Site Infections in Patients With Rheumatoid Arthritis Treated With Antitumor Necrosis Factor Alfa Therapy.

Risk of orthopedic surgical site infections in patients with rheumatoid arthritis treated with antitumor necrosis factor alfa therapy.

Filed under: Rehab Centers

Int J Rheumatol. 2012; 2012: 369565
da Cunha BM, Maria Henrique da Mota L, Dos Santos-Neto LL

Introduction. International guidelines recommend interruption of anti-TNF medications in the perioperative period, but there are no randomized trials to support such recommendation. Objectives. To study literature evidence assessing the risk of surgical site infections in orthopedic surgery patients with RA using anti-TNF drugs, compared to untreated patients or those using conventional DMARD. Methods. Systematic review of cohort studies is concerning surgical site infections in orthopedic procedures in patients with RA. Results. Three studies were selected. Only one was considered of high-quality, albeit with low statistical power. The review resulted in inconclusive data, since the best quality study showed no significant differences between groups, while others showed increased risk of infections in patients using anti-TNF medications. Conclusion. It is unclear whether patients with RA using anti-TNF medications are at increased risk of surgical site infections. Randomized controlled trials or new high quality observational studies are needed to clarify the issue.
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Alternative treatment for otitis media with effusion: eustachian tube rehabilitation.

Filed under: Rehab Centers

Acta Otorhinolaryngol Ital. 2012 Feb; 32(1): 26-30
D’Alatri L, Picciotti PM, Marchese MR, Fiorita A

In this study, we evaluated the effectiveness of eustachian tube rehabilitation (ETR) as treatment for otitis media with effusion (OME). Thirty-five children with persistent OME were enrolled. Patients were divided into three groups: group I (isolated OME); group II (OME and atypical swallowing); group II (OME, habitual mouth breathing and atypical swallowing). All children underwent ETR. Otomicroscopy and tympanograms were performed before treatment, and at one and three months following ETR. Considering the overall patient population after ETR (one and three months later), the prevalence of type A tympanogram increased significantly compared to before therapy (p < 0.005), while the prevalence of type B tympanogram decreased significantly (p < 0.005). We found significant differences between pre- and both post-therapy control in groups I and II. However, children in group II experienced significant improvement of middle ear conditions only three months after the end of therapy (p < 0.005). On the basis of the physiopathologic knowledge of OME and the underlying principles of ETR, we conclude that ETR can be considered a useful therapy in management of OME. HubMed – rehab


Thoracic surgery mortality and morbidity in a university hospital.

Filed under: Rehab Centers

Asian Cardiovasc Thorac Ann. 2012 Apr; 20(2): 182-7
Suksompong S, Thamtanavit S, von Bormann B, Thongcharoen P

This study was undertaken to determine the mortality and morbidity of lung resection surgery in the 2,415-bed Siriraj University Hospital, Thailand, and compare them to rates in similar facilities (benchmarking). Demographic and clinical data as well as perioperative outcome variables of patients who underwent elective thoracic surgery from January 2006 to May 2010 were reviewed retrospectively. There were 558 cases of lung resection. Mortality was 0.9% and perioperative morbidity was 8.2%. Univariate analysis identified age >75 years, history of pulmonary disease, preoperative rehabilitation consultation, and operative time >2 h as predictors of mortality and morbidity. With less statistical power, hypertension, cancer, peripheral vascular disease, and thoracotomy also contributed to perioperative outcome. Comparisons with data from the current literature place our results in the range of good quality. Following benchmarking criteria, perioperative outcomes after lung resection surgery in our hospital are good. To further improve quality, we will pay special attention to patients with advanced age and history of pulmonary disease.
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Patient-Centered Integrated Motor Imagery Delivered in the Home With Tele-rehabilitation to Improve Walking for an Individual Poststroke.

Filed under: Rehab Centers

Phys Ther. 2012 Apr 12;
Deutsch JE, Maidan I, Dickstein R

BACKGROUND AND PURPOSE:/b>This case report describes the clinical reasoning process used to examine and intervene with a person post-stroke that was selected to receive a novel integrated motor imagery (IMI) intervention for rehabilitation of walking that was delivered in the home using tele-rehabilitation. IMI consisted of patient-centered goal setting, physical practice combined with motor and motivational imagery. CASE DESCRIPTION: /b>The participant a 38-year-old woman was ten years post a diffuse left subarachnoid hemorrhagic stroke. She lived independently in an assisted living complex and carried a straight cane during long walks or unfamiliar environments. Examination revealed a slow gait speed, reduced walking endurance, and decreased balance confidence. Although she was in the chronic phase, we predicted that patient-centered IMI would improve her community mobility. Treatment sessions of 45-60 minutes were held 3 times a week, over 4 weeks. Tasks practiced included sit-stand, obstacle clearance and navigation in interior and exterior environments, which were first executed and then imagined at 1:5 ratios respectively. Task execution allowed creating a scene based on movement observation. Imagery scenarios were customized to addresses her movement problems and goals, based on her physical performance and imagery ability. Motivational elements of arousal, problem solving and reward were embedded in the imagery scenarios. Half the sessions were provided on-site and the remaining sessions were delivered remotely. OUTCOMES: /b>Improvements in motor imagery ability, gait parameters, and balance were obtained after training. Most gains were retained at three-month follow-up. Implementation of tele-rehab technology was tracked during training and costs were calculated after the intervention. DISCUSSION:/b>Delivery of IMI practice for walking recovery was feasible both in person and remotely.
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