The Effect of Bench Model Fidelity on Fluoroscopy-Guided Transforaminal Epidural Injection Training: A Randomized Control Study.
The Effect of Bench Model Fidelity on Fluoroscopy-Guided Transforaminal Epidural Injection Training: A Randomized Control Study.
Filed under: Rehab Centers
Reg Anesth Pain Med. 2013 Feb 4;
Gonzalez-Cota A, Chiravuri S, Stansfield RB, Brummett CM, Hamstra SJ
BACKGROUND AND OBJECTIVES: The purpose of this study was to determine whether high-fidelity simulators provide greater benefit than low-fidelity models in training fluoroscopy-guided transforaminal epidural injection. METHODS: This educational study was a single-center, prospective, randomized 3-arm pretest-posttest design with a control arm. Eighteen anesthesia and physical medicine and rehabilitation residents were instructed how to perform a fluoroscopy-guided transforaminal epidural injection and assessed by experts on a reusable injectable phantom cadaver. The high- and low-fidelity groups received 30 minutes of supervised hands-on practice according to group assignment, and the control group received 30 minutes of didactic instruction from an expert. RESULTS: We found no differences at posttest between the high- and low-fidelity groups on global ratings of performance (P = 0.17) or checklist scores (P = 0.81). Participants who received either form of hands-on training significantly outperformed the control group on both the global rating of performance (control vs low-fidelity, P = 0.0048; control vs high-fidelity, P = 0.0047) and the checklist (control vs low-fidelity, P = 0.0047; control vs high-fidelity, P = 0.0047). CONCLUSIONS: Training an epidural procedure using a low-fidelity model may be equally effective as training on a high-fidelity model. These results are consistent with previous research on a variety of interventional procedures and further demonstrate the potential impact of simple, low-fidelity training models.
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A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention.
Filed under: Rehab Centers
Soc Psychiatry Psychiatr Epidemiol. 2013 Feb 6;
Adegbaju DA, Olagunju AT, Uwakwe R
PURPOSE: Bipolar affective disorder (BAD) and schizophrenia are two severe psychotic conditions that are associated with disability. The present study was designed to compare the pattern of disability between clinically stable individuals with BAD and schizophrenia in a sub-Saharan mental health facility. METHODS: A total of 200 consecutive participants (made up of 100 each among clinically stable individuals with BAD and schizophrenia) were recruited. All participants had their diagnoses confirmed using Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), after which the designed questionnaire and the 36-item World Health Organisation Disability Assessment Schedule interview (WHODAS II) were administered to them. RESULTS: In this study, the level of disability among participants with BAD was better compared to those with schizophrenia as determined by mean WHODAS score of 24.93 and 27.02, respectively. Similarly, there was a significant difference between participants with BAD and schizophrenia with respect to four domains of the WHODAS-II, viz, self-care (p < 0.001), getting along with others (p < 0.001), life activities (p < 0.001) and participation in the society (p < 0.001). The factors that were significantly associated with disability in the two groups (BAD and schizophrenia) were: unemployment status (p < 0.001) and remittance source of income (p < 0.001), while those that spent not more than ?2,000 (13 dollars) per month on treatment (p = 0.004) were observed to be less disabled. CONCLUSIONS: Overall, participants with BAD fared better in the level of disability and most of the measured domains of disability in comparison with those with schizophrenia. Both socio-demographic and treatment-related factors seem to define the pattern disability among participants. Thus, evidence-guided preventive and rehabilitative treatment strategies directed against functional impairment using prioritized model among individuals with BAD and schizophrenia are advocated. HubMed – rehab
Long-term Results of a 12-Week Comprehensive Ambulatory Cardiac Rehabilitation Program.
Filed under: Rehab Centers
J Cardiopulm Rehabil Prev. 2013 Feb 4;
Blum MR, Schmid JP, Eser P, Saner H
PURPOSE:: To evaluate the long-term outcome of a 12-week outpatient cardiac rehabilitation (CR) program. METHODS:: In a prospective single-center interventional cohort study, 201 consecutive patients (133 patients after acute coronary syndrome, 32 patients after heart surgery, and 36 patients with heart failure) attending a 12-week comprehensive outpatient CR program were evaluated for exercise capacity, cardiovascular risk factors (CvRFs), and quality of life at entry, end, and 1.4 years after completion of the program (follow-up). RESULTS:: Physical exercise capacity improved significantly from program entry to program end and remained at this level at follow-up (P ? .006). CvRFs at follow-up were significantly reduced with regard to smoking prevalence and blood lipids (P < .001). At program end and follow-up, MacNew heart disease-specific emotional, physical, and social quality of life were improved significantly compared with those at program entry (P < .001). Use of cardioprotective medication remained equally high over the entire study period. However, significantly fewer patients reached blood pressure (<140/90 mm Hg, P = .034) and BMI (<30 kg/m, P = .017) goals at follow-up than at program end. CONCLUSION:: The 12-week comprehensive outpatient CR program was successful at reducing important CvRFs for a long term. HubMed – rehab
Nonventilatory strategies to prevent postoperative pulmonary complications.
Filed under: Rehab Centers
Curr Opin Anaesthesiol. 2013 Feb 3;
Güldner A, Pelosi P, Abreu MG
PURPOSE OF REVIEW: In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery. RECENT FINDINGS: Although nonavoidable, most comorbidities can be modified in order to reduce the incidence of pulmonary events postoperatively. The physical status of patients suffering from chronic obstructive pulmonary disease, asthma, obstructive sleep apnea, and congestive heart failure can be improved preoperatively, and a number of measures can be undertaken to prevent PPCs, including physiotherapy for pulmonary rehabilitation and drug therapies. Also, smokers may benefit from both short and long-term smoke cessation. Furthermore, the risk of PPCs may be reduced upon: choice of an adequate anesthesia strategy (e.g. regional vs. general); appropriate neuromuscular blockade and reversal; use of volatile instead of intravenous anesthetics in lung surgery; judicious intravascular volume expansion (restrictive vs. liberal strategy); regional instead of systemic analgesia after major surgery in high-risk patients; more strict indication for nasogastric decompression in order to avoid silent aspiration; and laparoscopic instead of open bariatric surgery. SUMMARY: Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.
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