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Introduction: Hospital affiliated green spaces can help patients recover and recover their physical functions, promote physical and mental relaxation, enhance health awareness, and improve overall health. However, there are still significant questions about how to scientifically construct hospital affiliated green spaces. This study examines the impact of hospital green spaces on patient rehabilitation through scientific evaluation methods, providing reference for the scientific construction of hospital affiliated green spaces. Applicability evaluation was conducted on the affiliated green spaces of three hospitals in Harbin. An evaluation system covering plants, space, accessibility, rehabilitation functions, and promotional and educational functions has been constructed. The entropy weight method is used to determine the weight of indicators, and the grey correlation analysis method is used to evaluate the suitability of green space for patient rehabilitation. Methods: The experimental results showed that the landscape accessibility index had the highest weight (0.3005) and the plant index had the lowest weight (0.1628), indicating that caring for special needs is the foundation of hospital landscapes, and plants have subtle and long-term effects on physical and mental health. In the evaluation of the rehabilitation applicability of the affiliated green spaces of various hospitals, the second hospital has the highest grey correlation degree (0.8525), followed by the tumor hospital (0.5306) and the fifth hospital (0.4846). It can be seen that the green space of the second hospital has high applicability for patient rehabilitation, but the green space of the tumor hospital and the fifth hospital needs to be improved and developed. Results and discussion: The evaluation criteria used in this study are comprehensive. The landscaping at the Third Hospital is well-planned with good plant configuration and reasonable spatial layout. However, there is insufficient consideration for accessibility in the landscape design, and the details are lacking. The rehabilitation and educational functions of the landscape are inadequate, with limited outdoor activities and low road safety. The hospital's affiliated green spaces should adhere to the principle of "appropriate scale, comprehensive functionality, and educational leisure," integrating rehabilitation and educational functions while increasing the variety of outdoor activities. In the future, emphasis should be placed on exploring the integration of landscape and rehabilitation to provide a functional site that is convenient for visiting, with improved rehabilitation facilities and an educational and enjoyable environment. The design should incorporate elements that contribute to a sense of well-being, including roads and.
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Entropía , Humanos , Hospitales , China , Arquitectura y Construcción de HospitalesRESUMEN
BACKGROUND: Patient activity after total knee arthroplasty (TKA) surgery has been estimated through patient-reported outcome measures. The use of data from an implanted sensor that transmits daily gait activity provides a more objective, complete recovery trajectory. METHODS: In this retrospective analysis of 794 patients who received a TKA with sensors in the tibial extension between October 4, 2021, and January 13, 2023, the average age of the patients was 64 years, and the cohort was 54.9% women. During the 6-week postoperative period, 90.3% of patients transmitted data. Patient activity in terms of qualified step count, cadence, walking speed, stride length, functional tibial range of motion (ROM), and functional knee ROM were compared at 1 week, 3 weeks, and 6 weeks postoperatively. RESULTS: All gait parameters increased in the first 6 weeks postsurgery: qualified step count increased 733%, cadence increased 22%, walking speed increased 50%, stride length increased 17%, tibial ROM increased 19%, and functional knee ROM increased 14%. There were statistically significant differences at both postoperative periods (P = .029, P < .001, and P < .001 at 3 and 6 weeks, respectively) in step counts for different body mass index (BMI) categories, with qualified step counts decreasing with increasing BMI. Patients under 65 years tended to have a higher qualified step count than those 65 and older at all time points, but these differences were not statistically significant. Men had significantly higher step counts than women (P < .001 at 1, 3, and 6 weeks). CONCLUSIONS: Initial results with an implanted sensor that collects data during activities of daily living confirm that 90% of patients transmit objective gait metrics daily after TKA surgery. Those results differ by sex and BMI. LEVEL OF EVIDENCE: III Retrospective Cohort Study.
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Artroplastia de Reemplazo de Rodilla , Marcha , Articulación de la Rodilla , Rango del Movimiento Articular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Marcha/fisiología , Articulación de la Rodilla/cirugía , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/fisiología , Recuperación de la Función , Medición de Resultados Informados por el Paciente , Osteoartritis de la Rodilla/cirugía , Periodo PosoperatorioRESUMEN
Background The COVID-19 pandemic has posed an unprecedented challenge to the global healthcare system, necessitating effective therapeutic strategies to mitigate its impact. This study investigates the significance of early antiviral therapy in the context of intensive care units (ICUs) and its potential to influence the progression and outcomes of severe COVID-19 cases. Methodology This retrospective cohort study leveraged a diverse patient population with confirmed severe COVID-19 admitted to ICUs. A total of 1,250 patients were included in the analysis, and their medical records were comprehensively reviewed. The study aimed to assess the impact of early antiviral therapy on patient outcomes, focusing on the administration of remdesivir within the first 48 hours of ICU admission. Results In a study of 1,250 COVID-19 patients, early antiviral therapy with remdesivir significantly reduced ICU admissions by 30% (N = 225) compared to standard care (N = 525). The early therapy group also exhibited a 20% lower mortality rate (N = 120) than the control group (N = 150). Demographic associations with antiviral usage were observed. Kaletra was favored by females, non-Saudi individuals, and healthcare workers, while favipiravir was associated with gender. Remdesivir and ribavirin use were linked to gender and Saudi nationality, while oseltamivir was related to gender, Saudi nationality, and body mass index. Microbiological cure rates were 15.4%, with 84.6% not achieving it. ICU outcomes included 37.7% deaths, 55.7% home discharges, and 6.6% transfers, while hospital outcomes featured 38.5% deaths, 54.4% home discharges, and 7.1% transfers. Conclusions This study presents a comprehensive analysis of COVID-19 patient demographics, antiviral medication associations, and clinical outcomes. The findings highlight the significance of tailoring treatment strategies based on patient characteristics and viral history. These insights contribute to a deeper understanding of COVID-19 management and can inform clinical decision-making and further research in this field.
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Mirror therapy is a standard technique of rehabilitation for recovering motor and vision abilities of stroke patients, especially in the case of asymmetric limb function. To enhance traditional mirror therapy, robotic mirror therapy (RMT) has been proposed over the past decade, allowing for assisted bimanual coordination of paretic (affected) and contralateral (healthy) limbs. However, state-of-the-art RMT platforms predominantly target mirrored motions of trajectories, largely limited to 2-D motions. In this paper, an RMT platform is proposed, which can facilitate the patient to practice virtual activities of daily living (ADL) and thus enhance their independence. Two similar (but mirrored) 3D virtual environments are created in which the patients operate robots with both their limbs to complete ADL (such as writing and eating) with the assistance of the therapist. The recovery level of the patient is continuously assessed by monitoring their ability to track assigned trajectories. The patient's robots are programmed to assist the patient in following these trajectories based on this recovery level. In this paper, the framework to dynamically monitor recovery level and accordingly provide assistance is developed along with the nonlinear controller design to ensure position tracking, force control, and stability. Proof-of-concept studies are conducted with both 3D trajectory tracking and ADL. The results demonstrate the potential use of the proposed system to enhance the recovery of the patients.
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INTRODUCTION: Chimeric antigen receptor-T cell (CAR-T) therapy has revolutionized advanced blood cancer treatment. However, preparation, administration, and recovery from these therapies can be complex and burdensome to patients and their care partners. Utilization of an outpatient setting for CAR-T therapy administration could help improve convenience and quality of life. METHODS: In-depth qualitative interviews were conducted with 18 patients in the USA with relapsed/refractory multiple myeloma or relapsed/refractory diffuse large B-cell lymphoma, 10 of whom had completed investigational or commercially approved CAR-T therapy and 8 of whom had discussed it with their physicians. We aimed to better understand inpatient experiences and patient expectations regarding CAR-T therapy and to ascertain patient perspectives on the possibility of outpatient care. RESULTS: CAR-T offers unique treatment benefits, particularly high response rates with an extended treatment-free period. All study participants completing CAR-T were very positive about their inpatient recovery experience. Most reported mild-to-moderate side effects; two experienced severe side effects. All said that they would opt to undergo CAR-T therapy again. Participants felt that the primary advantage of inpatient recovery was immediate access to care and on-going monitoring. Perceived advantages of the outpatient setting were comfort and familiarity. Because immediate access to care was seen as crucial, patients recovering in an outpatient setting would seek either a direct contact person or phone line for assistance if needed. CONCLUSION: As institutions become more experienced with CAR-T therapies, outpatient care may help reduce financial strain. Patient input can help institutions improve the outpatient experience and ensure safety and effectiveness of CAR-T programs.
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Background: Emergence delirium is a poorly understood incident in elderly patients in PACU. The aim of this study was to determine the incidence of emergence delirium and its predictors in elderly patients after general or spinal anesthesia for both elective and emergency surgery. Methods: In this prospective observational study, 172 consecutive patients were included. The study was performed in the post-anesthesia care unit for three months in 2020. We included elderly patients in both elective and emergency surgery. Patient interviews, chart reviews, and direct observation were among the data collection methods. The Nursing Delirium Screening Scale was the assessment tool. The outcome variable and independent variables' association was determined by bivariate and multivariate logistic regression analysis. Results: The incidence of emergence delirium at the post-anesthesia care unit was 40.7% (95% CI = 32-48).Postoperative pain (AOR = 3.9:95%CI = 1.13-13.60), preoperative anxiety (AOR = 7:95% CI = 1.76-28.55), perioperative narcotics (AOR = 5.1:95% CI = 1.27-20.57) and excessive blood loss (AOR = 6.5:95% CI = 2.47-17.02) were predictors of emergence delirium. Conclusions: Delirium in the post-anesthesia care unit is common. Anxiety, perioperative narcotics, and intraoperative blood loss were predictors of emergence delirium.
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The utility of pharmacist consultation for drug-induced liver injury (DILI) management has not been explored. This retrospective cohort study evaluated the impact of a pharmacist active consultation (PAC) service on the management and outcome in patients with DILI. Consecutive patients meeting clinical biochemical criteria for DILI were enrolled at a tertiary teaching hospital between 1 January 2020 and 30 April 2022. The Roussel Uclaf Causality Assessment Method was used to assess causality between drug use and liver injury for each suspected DILI patient. Included patients were grouped according to whether they received PAC, and a proportional hazard model with multivariate risk adjustment, inverse probability of treatment weighting (IPTW), and propensity score matching (PSM) was used to assess DILI recovery. In the PSM cohort, the quality of medical care was compared between PAC and no PAC groups. A total of 224 patients with DILI (108 who received PAC and 116 who did not) were included in the analysis. Of these patients, 11 (10%) were classified as highly probable, 58 (54%) as probable, and 39 (36%) as possible DILI in the PAC group, while six patients (5%) were classified as highly probable, 53 (46%) as probable, and 57 (49%) as possible DILI in the no PAC group (p = 0.089). During patient recovery, PAC was associated with a â¼10% increase in the cumulative 180-day recovery rate. The PAC group had a crude hazard ratio (HR) of 1.73 [95% confidence interval (CI): 1.23-2.43, p = 0.001] for DILI 180-day recovery, which remained stable after multivariate risk adjustment (HR = 1.74, 95% CI: 1.21-2.49, p = 0.003), IPTW (HR = 1.72, 95% CI: 1.19-2.47, p = 0.003), and PSM (HR = 1.49, 95% CI: 1.01-2.23, p = 0.046). In the PSM cohort, PAC was more likely to identify suspect drugs (90% vs. 60%, p < 0.001) and lead to timely withdrawal of the medication (89% vs. 57%, p < 0.001). Thus, PAC is associated with a better quality of medical care for patients with DILI and can improve patient outcomes.
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BACKGROUND: Intraperitoneal local anaesthetic has shown benefit in operative laparoscopy; however, no randomised controlled trial has been reported with patients having diagnostic laparoscopy. AIMS: To determine the effect of intraperitoneal ropivacaine on post-operative analgesic requirements, pain, nausea scores and recovery following gynaecological diagnostic laparoscopy and hysteroscopy. MATERIALS AND METHODS: Randomised double-blind placebo-controlled trial. Well women aged 18-50 years, undergoing day case hysteroscopy and diagnostic laparoscopy for gynaecological indications were randomised to 20 mL of 150 mg intraperitoneal ropivacaine diluted in saline, or 20 mL normal saline instillation (placebo) at the end of the procedure. Women were followed up until eight hours post-discharge. RESULTS: Slower than anticipated recruitment meant that the study was finished before the sample size of 100 patients was achieved. Fifty-nine patients were included for analysis. Thirty-one patients were randomised to ropivacaine and 28 patients to control. Sixty-one percent of patients in both arms required opioid medication in recovery. The total median equivalent morphine dose was significantly higher in the patients randomised to control (11.7 mg) vs ropivacaine (6.7 mg), P = 0.03. Time to discharge was 20 min faster in patients randomised to ropivacaine, but this finding did not reach significance. Overall pain and nausea scores in the first eight hours showed no significant differences. CONCLUSION: There was significantly reduced opioid use in recovery when using intraperitoneal ropivacaine compared to placebo, in this randomised placebo-controlled trial on women undergoing day case diagnostic laparoscopy and hysteroscopy.
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Histeroscopía , Laparoscopía , Adolescente , Adulto , Cuidados Posteriores , Analgésicos Opioides/uso terapéutico , Anestésicos Locales/uso terapéutico , Método Doble Ciego , Femenino , Humanos , Histeroscopía/efectos adversos , Laparoscopía/métodos , Persona de Mediana Edad , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/tratamiento farmacológico , Alta del Paciente , Embarazo , Ropivacaína/uso terapéutico , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Prehabilitation is defined as preoperative conditioning of patients in order to improve post-operative outcomes. Some studies showed an increase in functional recovery following colorectal surgery, but its effect in hepato-pancreato-biliary (HPB) surgery is unclear. The aim of this study was to realize a systematic literature review and meta-analysis on the current available evidence on prehabilitation in HPB surgery. MATERIALS AND METHODS: A systematic review and a metanalysis were carried out on prehabilitation (physical, nutritional and psychological interventions) in HPB surgery (2009-2019). Assessed outcomes were postoperative complications, length of stay (LOS), 30-day readmission, and mortality. MAIN RESULTS: Four studies among the 191 screened were included in this systematic review (3 randomized controlled trials, 1 case-control propensity score study), involving 419 patients (prehabilitation group, n=139; control group, n=280). After pooling, no difference was observed on LOS ((-4.37 days [95% CI: -8.86; 0.13]) or postoperative complications (RR 0.83 [95%CI: 0.62; 1.10]), reported by all the included studies. Two trials reported on readmission rate, but given the high heterogeneity, a meta-analysis was not realized. No deaths were reported among the included studies. CONCLUSION: No effect of prehabilitation programs in HPB surgery was observed on LOS or postoperative complications rate. Future trials with standardized outcomes of measure, and adequately powered samples calculations are thus required. PROSPERO REGISTRATION: CRD42020165218.
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Procedimientos Quirúrgicos del Sistema Digestivo , Ejercicio Preoperatorio , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Humanos , Tiempo de Internación , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Ensayos Clínicos Controlados Aleatorios como Asunto , Tamaño de la MuestraRESUMEN
PURPOSE: To assess if application of dual-layer compression bandage to osteotomy patients post-surgery can positively influence levels of post-operative pain and swelling. PATIENTS & METHODS: Prospective, single-centre, randomised controlled trial comparing standard care, non-compression bandaging, versus Coban™ 2 (3M). Seven day application of the latter to index leg of osteotomy patients. RESULTS: Primary outcome data was available for 36 out of 49 study subjects (18 standard care versus 18 Coban™ 2 subjects). Median 10-cm scale pain levels showed a statistically non-significant difference at day 5 and day 12 post-surgery between standard care and Coban™ 2 respectively: 5.5 cm vs 2.5 cm (p-value 0.068) and 4.0 cm vs 2.3 cm (p-value 0.39). However, on day 12 (p-value 0.029) and week 6 (p-value 0.027), 'throbbing pain' was significantly higher for Coban™ 2 patients. Changes in limb swelling measures, comparing before and after the surgical procedure, did not differ between treatment arms. Compression led to more patients reporting bandage-related discomfort (6% standard care versus 63% Coban™ 2 patients). CONCLUSION: Compression bandaging changes the post-surgery pain profile in osteotomy patients, but does not reduce leg swelling. Any subsequent leg compression trials must take into account patient comfort and titrate intervention length and compression rates.
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Vendajes de Compresión , Dolor Postoperatorio , Humanos , Osteotomía , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: There has been a 65% increase in lumbar spinal fusion surgery (LSFS) worldwide over the last 13 years, with costs of £26 million to the UK National Health Service annually. Patient dissatisfaction with outcome and persistent pain and disability incurs further costs. Three trials provide low-quality evidence for the role of physiotherapy. Our UK surveys investigating physiotherapy/surgeon practice concluded rehabilitation should be tailored to the individual patient owing to considerable clinical heterogeneity. This study will explore the perceptions of patients who undergo LSFS to inform precision rehabilitation. METHODS AND ANALYSIS: A qualitative study, using interpretive phenomenological analysis, will recruit a purposive sample (n=40) to ensure patterns of similarity and difference in their journeys can be explored. In-depth semistructured interviews will be undertaken following discharge from hospital and at 12 months postsurgery. Patients' preoperative and postoperative experiences, underlying attitudes and beliefs towards the surgical intervention, facilitators and barriers to recovery, adherence to advice and physiotherapy, experiences of rehabilitation and return to normal function/activity/work will be explored. A 12-month patient diary will provide real time access to patient data, capturing a weekly record of life as lived, including symptoms, medication, experiences of stages of recovery, rehabilitation adherence, healthcare professional appointments, attitudes, their feelings and experiences throughout their journey. Data will be analysed in a number of stages in accordance with interpretive phenomenological analysis, supported using NVivo software. Analysis of the first interviews and patient diaries will afford a rich density of data to build an overall understanding of the patients' lived experiences, informing the 12-month interview. Strategies (eg, reflexivity) will ensure trustworthiness. ETHICS AND DISSEMINATION: The study has ethical approval (IRAS 223283). Findings will ensure that patient-driven data inform precision rehabilitation by understanding the patient journey. Findings will be disseminated through peer-reviewed journals and conferences.
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Vértebras Lumbares/cirugía , Región Lumbosacra/cirugía , Especialidad de Fisioterapia/métodos , Fusión Vertebral/rehabilitación , Humanos , Entrevistas como Asunto , Manejo del Dolor , Investigación Cualitativa , Calidad de Vida , Proyectos de Investigación , Fusión Vertebral/economíaRESUMEN
In maxillofacial head and neck oncology, tracheostomy is often used to secure the airway, but not without risk. This study compared the existing practice of two units: one where tracheostomy was routinely done with one where overnight intubation was used. From both units we retrospectively analysed 50 consecutive patients who had intraoral resection, neck dissection, and microvascular reconstruction for head and neck cancer. When compared with tracheostomy, overnight intubation resulted in a shorter mean stay in the intensive therapy unit (ITU) (1.4 compared with 3.7 days), a shorter overall hospital stay (12.9 compared with 18.0 days), less time to first oral intake (8.9 compared with 12.8 days), and a lower rate of lower respiratory tract infection (LRTI) (10% compared with 38%). This study supports the discontinuation of routine tracheostomy and the adoption of a more selective practice to improve recovery.
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Manejo de la Vía Aérea/métodos , Neoplasias de Cabeza y Cuello/cirugía , Intubación Intratraqueal/métodos , Recuperación de la Función/fisiología , Traqueostomía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Cuidados Críticos , Nutrición Enteral , Femenino , Estudios de Seguimiento , Colgajos Tisulares Libres/trasplante , Hospitalización , Humanos , Tiempo de Internación , Masculino , Mandíbula/cirugía , Microcirugia/métodos , Persona de Mediana Edad , Disección del Cuello/métodos , Estadificación de Neoplasias , Cuidados Posoperatorios , Procedimientos de Cirugía Plástica/métodos , Infecciones del Sistema Respiratorio/prevención & control , Estudios Retrospectivos , Adulto JovenRESUMEN
El glaucoma pigmentario es el más frecuente de los glaucomas secundarios. Se presenta en pacientes jóvenes durante la tercera o cuarta década de la vida y el diagnóstico se realiza en una etapa de daño glaucomatoso avanzado con graves secuelas visuales, por lo que genera un gran impacto social. El propósito de este trabajo es realizar una actualización del tema a fin de perfeccionar el manejo y el tratamiento del síndrome de dispersión pigmentaria/glaucoma pigmentario, e incidir satisfactoriamente en la evolución de los pacientes.
Pigmentary glaucoma is the most frequent of secondary glaucoma. It occurs in young patients in the third or fourth decade of life and the diagnosis is made in an advanced stage of glaucomatous damage with serious visual sequelae and a great social impact. The purpose of this paper was to update this topic in order to improve the management and treatment of pigmentary dispersion syndrome and pigmentary glaucoma, and to have a positive effect on the recovery of these patients.