Activity In Patients Research Articles

The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial.

Purpose: Self-management is widely used among patients with a chronic disease to control their condition. However, the self-management programs are less distinctive for patients with chronic obstructive pulmonary disease (COPD) than those with other chronic diseases. This study examines the efficacy of a flipping education program on improving self-management in patients with COPD.Patients and methods: A single-blinded, randomized controlled trial was conducted at a medical center in northern Taiwan from January 2015 to May 2016. Sixty participants were randomized to an experimental group and a control group. The self-management program with flipped teaching, customized action plans, and scheduled telephone interviews was implemented in the experimental group for three months. Conventional patient education was implemented in the control group. Disease knowledge, self-efficacy, the patient’s activation level, and the impact of COPD were assessed at baseline, 1 month, and 3 months after the intervention. SPSS 22.0 was used for data analysis.Results: The results showed that the patients who received the flipping education program of self-management had statistically significant improvements in their disease knowledge (p<0.05), self-efficacy (p<0.01), and activation levels (p<0.01) from baseline to the 1 month and 3 months follow-up compared to the control group.Conclusion: The findings supported that flipped teaching could be applied to patient education in adults and that a nurse case manager can feasibly use this flipping education program of self-management to motivate and support patients with COPD to acquire self-management skills, carry out their action plans, and help them achieve beneficial behaviors in their daily lives.

The advantages of patient's active involvement in the management of chronic Inflammatory Bowel Diseases.

The patient's active involvement is an emerging hot-topic, which can be applied in to the management of chronic inflammatory bowel diseases (IBD). Since in this field most of the therapeutic strategies are not based on sturdy scientific evidences, the patient's role has become central and it is believed essential for any patients to have an active cognitive, behavioural and emotive profile. Moreover different patient's aspects should be considered, such as the patient's activation, the patient's engagement and the patient's disease knowledge. The initial evidences available on this topic within IBD context have showed how a higher patient's active profile and a deeper disease knowledge have had a positive effect on compliance, perceived health-care satisfaction, self-management and health costs. Therefore, considering the favourable outcomes so far highlighted, we hope that the evaluation of patient's involvement may become a standard procedure, allowing patients who need it to undergo active programmes which have proved to be effective in improving patient's degree of activation.

Economic burden of incident interstitial lung disease (ILD) and the impact of comorbidity on costs of care

Evidence about the economic burden related to interstitial lung diseases (ILDs) and the cost-driving factors is sparse. In the knowledge that distinct comorbidities affect the clinical course of ILDs, our study investigates their impact on costs of care within first year after diagnosis. Using claims data of individuals diagnosed with Idiopathic Interstitial Pneumonia (IIP) (n = 14 453) or sarcoidosis (n = 9106) between 2010 and 2013, we calculated total and ILD-associated mean annual per capita costs adjusted by age, sex and comorbidity burden via Generalized Linear Gamma models. Then, we assessed the cost impact of chronic obstructive pulmonary disease (COPD), diabetes, coronary artery disease, depression, gastro-esophageal reflux disease, pulmonary hypertension (PH), obstructive sleep apnoea syndrome (OSAS) and lung cancer using the model-based parameter estimates. Total mean annual per capita costs were €11 131 in the pooled cohort, €12 111 in IIP and €8793 in sarcoidosis, each with a 1/3 share of ILD-associated cost. Most comorbidities had a significant cost-driving effect, which was most pronounced for lung cancer in total (1.989 pooled, 2.491 sarcoidosis, 1.696 IIP) and for PH in ILD-associated costs (2.606 pooled, 2.347 IIP, 3.648 sarcoidosis). The lung-associated comorbidities COPD, PH, OSAS more strongly affected ILD-associated than total costs. Comorbidities increase the already substantial costs of care in ILDs. To support patient-centred ILD care, not only highly cost-driving conditions that are inherent with high mortality themselves require systematic management. Moreover, conditions that are more rather restricting the patient's activities of daily living should be addressed - despite a low-cost impact.

Bicruciate-stabilised total knee arthroplasty provides good functional stability during high-flexion weight-bearing activities.

Bicruciate-stabilised total knee arthroplasty (BCS-TKA) uses a dual-post-cam mechanism as a substitute for the anterior cruciate ligament and posterior cruciate ligament (PCL), with the surface geometry providing additional guidance for axial rotation and posterior translation. However, the effect of weight-bearing on the kinematics of BCS-TKA has not been investigated. Therefore, the aim of this study was to clarify the effect of weight-bearing on the kinematics of BCS-TKA during high-flexion activities. The kinematics of 11 BCS-TKAs were evaluated under fluoroscopy, with two- and three-dimensional image registration, during squatting weight-bearing and active-assisted knee flexion non-weight-bearing. The following variables were measured: knee range of motion, axis of femoral rotation relative to the tibial component, anteroposterior (AP) translation of the medial contact point, kinematic path of the joint surfaces, lateral femorotibial contact point, and anterior and post-cam engagement. The weight-bearing condition did not influence the range of knee flexion, axis of femoral rotation, medial pivot pattern during early flexion, or bicondylar rollback beyond mid-flexion. With regard to AP translation, both the medial and lateral contact points had more posterior locations in weight-bearing than in non-weight-bearing at the mid-flexion angle. Anterior engagement was identified in 6/11 knees (54.5%) in weight-bearing and 4/11 knees (36.3%) in non-weight-bearing. Post-cam engagement was observed in all knees, with the angle of flexion at engagement being larger in weight-bearing than in non-weight-bearing. Although weight-bearing resulted in a posterior location of the medial and lateral contact points of the BCS-TKA design compared with non-weight-bearing in the mid-range of knee flexion, the amount of anterior translation was small overall. Therefore, BCS-TKA provides good stability during high-flexion weight-bearing activities. However, BCS-TKA is associated with high rate of the anterior engagement during early flexion. Therefore, understanding a patient's activities is an important factor when selecting the most appropriate TKA method.

Development and validation of the healthcare providers patient-activation scale

ObjectiveIt has become increasingly important to assess healthcare providers’ role in chronic disease self-management (CDSM) and patient activation (PA). The present study extends previous work relating to patients’ behaviours by assessing healthcare providers’ own behaviours in supporting PA. Method50 items were generated: half assessed a PA approach; half reflected a non-patient-activation approach. 105 healthcare providers working in cardiac rehabilitation who were participants in a CDSM online training program completed the items pre- and post-training. Factor analysis determined the presence of higher order factors. Item responses pre- and post-training were compared to assess sensitivity to change. ResultsResults indicated the presence of two factors: ‘patient-activation approach’ and ‘non-patient-activation approach’. While both demonstrated good internal consistency, the’ non-PA approach’ had superior discriminatory validity and sensitivity to change. ConclusionHealthcare providers’ beliefs about the importance of patient-activation behaviours can be measured by 40-item Healthcare Provider-Patient Activation Scale (HP-PAS). The scale could be easily converted to measure healthcare providers’ actual PA behaviours. Practice implicationsThe HP-PAS could be used to assess the effectiveness of clinician training for healthcare providers working in cardiac rehabilitation and other areas of CDSM. Further reliability and validity testing within other healthcare provider samples is warranted.

How health literacy and patient activation play their own unique role in self-management of chronic obstructive pulmonary disease (COPD)?

Current evidence indicates that although they are correlated, health literacy (HL) and patient activation (PA) are distinct. This article describes how HL, PA and their determinants intersect and diverge and how these concepts might inform the development of self-management interventions. The concepts of HL and PA contribute to self-management interventions in different ways. HL includes the skills and confidence required for self-management while PA focuses more on motivation and ability to take action. In this light, communication of concepts on HL and PA needs to be more widely understood by academics, researchers and policy experts as each of them plays a unique role in promoting self-management for long-term conditions such as chronic obstructive pulmonary disease.

Predictive factors of the neuropathic pain in patients with carpal tunnel syndrome and its impact on patient activity.

To determine the predictive factors of the neuropathic pain in patients with carpal tunnel syndrome (CTS), and the impact of such neuropathic pain on patient's activity. Douleur Neuropathique 4 questionnaire, Short Form-Brief Pain Inventory test and Boston Carpal Tunnel Syndrome Questionnaire were completed and results were stratified according neuropathic pain and work activity of the patients. 69 of 90 patients with CTS had neuropathic pain (76.7%). Increasing by one the scores of numbness/tingling, pain intensity and neurologic affectation of the electromyogram meant increasing 3.3-, 2.7- and 4.4-times the risk of neuropathic pain, respectively. These results will be useful for a better neuropathic pain evaluation in patients with CTS, allowing the appropriate treatment.

Using only MRI is moderately reliable in the prediction of meniscal tear reparability.

The purpose of this study was to evaluate the role of surgeons' experience with meniscal repairs and meniscectomy decisions, and to determine the factors affecting the disagreement between meniscal repairs and meniscectomy decisions. In total, 223 patients with meniscal tears, 106 meniscal repairs, and 117 meniscectomies were included. Six orthopedic surgeons (3: > 5years; 3: < 5years' arthroscopy experience) were blinded, and they independently reviewed all preoperative MR images for over a month. Their reviews were compared with arthroscopic interventions performed by a surgeon with > 10years' arthroscopy experience. Reparability-associated factors were also evaluated using multivariate logistic regression. The first and second evaluation results did not differ significantly between groups (n.s.). There was good agreement between MRI predictions and arthroscopic interventions for both groups (< 5years' experience: k = 0.248, agreement 62.3%; > 5years' experience: k = 0.351, agreement 67.3%). Sex, side, and distance of tear from the meniscocapsular junction were not significantly different between agreements and disagreements. Disagreement regarding meniscectomy was significantly higher than those regarding meniscus repair (p = 0.002). Concomitant anterior cruciate ligament (ACL) injury, osteochondral lesions, and medial meniscal tear increased the likelihood of meniscal repair (p = 0.0063, p = 0.0010, and p = 0.0369, respectively). An increased risk of disagreement between MRI and surgical procedure was found in the presence of bucket-handle, horizontal or complex tear, chronic tear, high sports activity and expectation level. Surgeon's experience level may influence the prediction of meniscus reparability. Concomitant ACL injury, osteochondral lesions, and presence of medial meniscal tear increase the likelihood of meniscal repair. Tear type, tear chronicity, patient's activity and expectation level may influence the surgeon's operative decision in addition to MRI. III.

Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance.

Increasing left ventricular assist device (LVAD) pump speed according to the patient's activity is a fascinating hypothesis. This study analyzed the short-term effects of LVAD speed increase on cardiopulmonary exercise test (CPET) performance, muscle oxygenation (near-infrared spectroscopy), diffusion capacity of the lung for carbon monoxide (Dlco) and nitric oxide (Dlno), and sleep quality. We analyzed CPET, Dlco and Dlno, and sleep in 33 patients supported with the Jarvik 2000 (Jarvik Heart Inc., New York, NY). After a maximal CPET (n = 28), patients underwent 2 maximal CPETs with LVAD speed randomly set at 3 or increased from 3 to 5 during effort (n = 15). Then, at LVAD speed randomly set at 2 or 4, we performed (1) constant workload CPETs assessing O2 kinetics, cardiac output (CO), and muscle oxygenation (n = 15); (2) resting Dlco and Dlno (n = 18); and (3) nocturnal cardiorespiratory monitoring (n = 29). The progressive pump speed increase raised peak volume of oxygen consumption (12.5 ± 2.5 ml/min/kg vs 11.7 ± 2.8 ml/min/kg at speed 3; p = 0.001). During constant workload, from speed 2 to 4, CO increased (at rest: 3.18 ± 0.76 liters/min vs 3.69 ± 0.75 liters/min, p = 0.015; during exercise: 5.91 ± 1.31 liters/min vs 6.69 ± 0.99 liters/min, p = 0.014), and system efficiency (τ = 65.8 ± 15.1 seconds vs 49.9 ± 14.8 seconds, p = 0.002) and muscle oxygenation improved. At speed 4, Dlco decreased, and obstructive apneas increased despite a significant apnea/hypopnea index and a reduction of central apneas. Short-term LVAD speed increase improves exercise performance, CO, O2 kinetics, and muscle oxygenation. However, it deteriorates lung diffusion and increases obstructive apneas, likely due to an increase of intrathoracic fluids. Self-adjusting LVAD speed is a fascinating but possibly unsafe option, probably requiring a monitoring of intrathoracic fluids.

Patient activation for self-management is associated with health status in patients with atrial fibrillation.

BackgroundHigher levels of patient activation for self-managing health are associated with positive clinical and health care utilization outcomes. Identifying a patient’s activation level can guide clinicians to tailor interventions to improve their health. Effective self-management of atrial fibrillation (AF) requires patient activation to participate in treatment decisions, prevent complications, and manage risk factors. Yet, little is known about activation in patients with AF. The purpose of this descriptive study was to identify patient activation levels and factors associated with activation in patients with AF.MethodsPatients (N=123), 66% male, with a mean (SD) age of 59.9 (11.3) years seeking treatment for AF at an arrhythmia clinic completed the Patient Activation Measure (PAM), Atrial Fibrillation Severity Scale, Knowledge about Atrial Fibrillation test, Hospital Anxiety Depression Scale, Godin Leisure-Time Exercise Questionnaire, and Patient Assessment of Chronic Illness Care. Sociodemographic and clinical data were obtained from medical records. PAM scores were categorized into Levels 1–4. Associations among patient-reported outcomes, sociodemographic, and clinical variables were analyzed using Fisher’s exact tests and Kruskal–Wallis procedures.ResultsThe PAM scores of nearly half (45.5%) of the patients were at Level 3, while the scores of 38% were at Level 4. Male sex (P=0.02), higher education (P=0.004), being employed (P=0.005), lower body mass index (P=0.03), tobacco abstinence (P=0.02), less AF symptom burden (P=0.006), less depression (P≤0.0001) and anxiety (P=0.006), greater knowledge of AF (P=0.01), and higher levels of physical activity (P=0.02) were associated with higher activation levels.ConclusionHigher levels of patient activation in those with AF were associated with a more positive health status and educational attainment. Additional research to describe activation in patients with AF is warranted to identify patients at risk for low activation and to tailor interventions to activation level.

The Effect of Polydeoxyribonucleotide on Chronic Non-healing Wound of an Amputee: A Case Report.

Polydeoxyribonucleotide (PDRN) is safe and effective in wound healing, cellular growth, synthesis of extracellular matrix protein, and inflammation reduction via activation of adenosine A2 receptors. We report a 28-year-old male patient treated with PDRN injections for chronic non-healing wound refractory to negative pressure wound therapy, skin graft, or growth factors. Three injections of PDRN were administered at the wound site into the anterior and medial sides of the left stump on the 1st, 4th, and 9th days of hospitalization. The PDRN ameliorated wound healing by enhancing cell growth, tissue repair, and angiogenesis. PDRN application represents a potential treatment for non-healing wounds obviating the need for additional therapies, and hospitalization, as well as improve patient’s activities of daily living.

Surgical Treatment for Scoliosis

Recently, patients with spinal deformities, particularly scoliosis, could be handled well through surgical pathways. Generally, surgery is indicated in patients with scoliosis curve exceeding 45 degrees (COBB angle&gt; 45). The ultimate goal is to reduce the curve as optimally as possible without disturbing spinal cord. Whether the result is straight or not, it also depends on the patient's spine flexibility before surgery.Surgical indications are for improving appearance, preventing increasing degrees of the curve, preventing interference to other organs such as the lungs, and preventing neurological deficits. Correction of Cobb angle below 25 degrees had already makes the patient feel more comfortable. The amount of screw and instrumentation length depends on the number of spines involved. After surgery treatment, 2-4 weeks of rest are required before returning to daily activity.Fusion principle states that the spine will be slightly stiff in order to be corrected but it is believed that patient's activity could still be done with the remaining flexibility. Surgical treatment of scoliosis that does meet the indications is imperative and relatively safe with advances in medical technology today.

Higher patient activity level and subchondral stiffening in asymptomatic cam femoroacetabular impingement subjects.

ABSTRACTA cam deformity is proposed as a cause of idiopathic osteoarthritis. Increased subchondral bone mineral density (BMD) is associated with this degenerative process of osteoarthritis, and the patient’s activity level may contribute to it. Therefore, the correlation between activity level and subchondral BMD in subjects with cam deformity FAI was studied. In this study, 26 asymptomatic cam deformity subjects (Bump) were compared with 18 subjects with a normal alpha angle (Control). Anterosuperior subchondral femoral neck and acetabular rim BMD were measured using quantitative computed tomography. Activity level was determined using the UCLA activity score. The correlation between BMD and UCLA activity were analysed. The result was a significantly higher BMD for Bump subjects in almost all measured sections. The UCLA score of the Bump versus Control subjects were comparable (8.96 versus 8.77, P = 0.740). While the controls showed no correlation between UCLA and BMD, a positive correlation was found for the Bump subjects on several femoral and acetabular impingement locations. These results support the conclusion that mechanical loading causes subchondral stiffening at the anterosuperior head–neck junction of the femur and anterosuperior acetabular rim. The absence of a correlation between BMD versus UCLA in the Controls supports the hypothesis that activity level may serve as a predictor for higher subchondral BMD in a cam deformity hip joint.

Does arthroscopic rotator cuff repair improve patients' activity levels?

Rotator cuff repair decreases pain, improves range of motion, and increases strength. Whether these improvements translate to an improvement in a patient's activity level postoperatively remains unknown. The Shoulder Activity Level is a valid and reliable outcomes survey that can be used to measure a patient's shoulder-specific activity level. Currently, there are no studies that examine the effect of rotator cuff repair on shoulder activity level. Preoperative patient-determined outcomes scores collected prospectively on patients undergoing rotator cuff repair were compared with postoperative scores at a minimum of 2 years. These scores included the Shoulder Activity Level, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, and simple shoulder test. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. Included were 281 shoulders from 273 patients with a mean follow-up of 3.7 years. The postoperative median Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), Single Assessment Numeric Evaluation (30 vs. 95), and simple shoulder test (4 vs. 11) scores were statistically significantly improved compared with preoperative scores (P < .0001). The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11; P < .0001). Patients reported a statistically significant deterioration of their Shoulder Activity Level score after rotator cuff repair compared with their preoperative scores, although disease-specific and joint-specific quality of life scores all had statistically significantly improvement. This study suggests that patients generally have (1) significant improvements in their quality of life and (2) small deteriorations in activity level after arthroscopic rotator cuff repair.

Does total shoulder arthroplasty improve patients' activity levels?

Total shoulder arthroplasty (TSA) decreases pain, improves range of motion, and increases strength. Whether these improvements translate to improvements in activity levels postoperatively remains unknown. The Shoulder Activity Level (SAL) is a valid and reliable outcomes survey that measures the patient's activity level. Currently, no studies have specifically examined the effect of TSA on SAL. A prospective collection of preoperative, patient-determined outcomes on patients undergoing TSA was compared with postoperative scores at a minimum of 2 years. These scores included the SAL, Western Ontario Osteoarthritis of the Shoulder Index (WOOS), American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment, Single Assessment Numeric Evaluation (SANE), and the Simple Shoulder Test (SST). Inclusion criteria were patients undergoing primary anatomic TSA or reverse TSA. A mean follow-up of 3.7 years was available for 80 anatomic and 42 reverse TSAs. Anatomic TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (34 to 89; P < .0001), ASES (30 to 87; P < .0001), SST (2 to 9; P < .0001), and SANE scores (23 to 90; P < .0001). The SAL improved from 7 to 8 but did not quite reach statistical significance (P = .07). Reverse TSAs had improvements from median preoperative scores to median postoperative scores for WOOS (31 to 83; P < .0001), ASES (29 to 82; P < .0001), SST (2 to 7; P < .0001), and SANE scores (20 to 85; P < .0001). The SAL improved from 4.5 to 6, but this did not reach statistical significance (P = .38). However, when anatomic and reverse TSAs were analyzed together, a statistically significant improvement was found postoperatively in the SAL (from 6 to 8; P = .006). Anatomic TSA and reverse TSA improved activity levels. In addition, disease-specific and joint-specific quality of life scores all had statistically significant improvements. This study suggests that after shoulder arthroplasty patients in general have (1) significant improvements in their quality of life and (2) have small improvements in activity level. This study shows that most patients do not have to decrease their activity levels to diminish symptoms to an acceptable range.

SEROPREVALENCE OF ANTI-MANNOSE BINDING LECTIN AUTOANTIBODIES IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SANA'A CITY- YEMEN

Objective: Rheumatoid arthritis (RA) characterized by synovial inflammation and destruction of cartilage and bone. Until now there is no single test that diagnoses RA, however, several blood tests may suggest the presence of this disease. RA is associated with the presence of a number of autoantibodies as such as rheumatoid factor (RF), anti-cyclic citrullinated peptide (ACPA) and anti-mannose binding lectin (anti-MBL). This study aimed firstly to investigate the presence of anti-MBL autoantibodies in the sera of RA patients and healthy controls and secondly to determine the diagnostic value of this marker in comparison with the classical RF, C- reactive protein (CRP) and ACPA among RA cases. Methods: This case-control study was conducted at four health establishments; two public (Al-Thawra Modern General Hospital and National Center of Central Public Health Laboratories) and two private (University of Science and Technology Hospital and Aulqi Specialized Medical Laboratories) in Sana'a city. Ninety-four individuals were enrolled in this study. Forty-seven persons were clinically diagnosed to have RA by a rheumatologist and 47 healthy subjects without RA were used as controls. Sera were separated and tested for presence of serum anti-MBL autoantibodies, ACPA, RF and CRP by a commercially available enzyme linked immunosorbent assay (ELISA) and latex agglutination technique. Results: Study results showed that the mean±SD for the levels of serum anti-MBL autoantibodies among RA cases were 394±243 ng/ml which were significantly higher than that recorded among healthy controls (217±173 ng/ml). The levels of serum anti-MBL autoantibodies were associated with positive RF and CRP tests (p=.02 and .007 respectively), but not with positive ACPA test (p=.42). Conclusion: The result of this study showed higher levels of serum anti-MBL autoantibodies among RA cases comparing with the healthy controls and reveal an association with positive results for RF and CRP, but not with ACPA. Therefore, the anti-MBL antibody levels may associated with systemic autoimmune diseases and might not exclusive to RA. Peer Review History: Received 8 May 2018; Revised 12 May; Accepted 14 May, Available online 15 May 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Ahmad Abdelsattar El-Ebiary, Tanta University Hospitals, Tanta, Egypt, a.ebiary@med.tanta.edu.eg Dr. Anthony C. C. Egbuonu, Michael Okpara University of Agriculture, Nigeria, tonycemalukegbuonu@yahoo.com Similar Articles: PREVALENCE OF DYSLIPIDEMIA AND ITS ASSOCIATION WITH DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SULAIMANI GOVERNORATE THE ASSOCIATION OF EPSTEIN-BARR VIRUS ANTIBODIES WITH RHEUMATOID ARTHRITIS AMONG YEMENI PATIENTS IN SANA’A CITY INTERLEUKIN-22 SERUM LEVELS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN SANA'A CITY, YEMEN

Assessing Clinicians' Endorsement of Patient Activation in Health Management

Abstract Chronic condition management requires strategies to mobilize patients as active partners in their health. Primary care providers (PCPs) play a unique role in influencing patient activation (PA). This practice-based study explored the impact of a PCP-PA–tailored training on clinician adoption of strategies to influence PA. Before training, clinicians completed the Clinician Support for Patient Activation Measure survey, assessing their beliefs in PA, with 55% endorsing the importance of patient knowledge/involvement. In contrast, 1-month after training, over 85% agreed they were confident in recognizing the level of PA, and 71% reported modifying their practice to impact PA. Gains were retained at 3 months posttraining.

Management of lower limb amputations.

The most common reason for lower limb amputations in the UK is peripheral arterial disease. A thoughtful approach to surgery, with consideration of optimal amputation level and residual limb shape, can improve prosthetic use and functional outcomes. Prosthesis socket design and fit, as well as use of appropriate components, must be considered in accordance with the patient's activity level and potential. Major developments in prosthetics over the past 20 years, particularly in the area of joint design, including microprocessor knees, have increased options to improve ambulation. This is particularly significant among those with more proximal amputations, for whom energy expenditure on walking is even greater. Management of post-amputation pain syndromes including phantom limb pain can prove challenging, although there are novel options for pain control. Long-term care of both the residual and contralateral limbs is paramount to reduce risk of further amputation surgery, and optimize longer term function and quality of life.

Correlation among sarcopenia, malnutrition and activities of daily living in patients with vertebral compression fractures: a comparison based on admission and discharge parameters evaluating these conditions.

[Purpose] Sarcopenia may be associated with malnutrition in patients with vertebral compression fractures which may affect a patient’s functional prognosis. This study investigated the association between sarcopenia, malnutrition, and activities of daily living at the time of hospital discharge in patients with vertebral compression fractures. [Participants and Methods] The study included 36 patients who were hospitalized with vertebral compression fractures. Sarcopenia was assessed by measuring grip strength and calf circumference. The nutritional status was assessed at the time of hospital admission and at discharge using the Mini Nutritional Assessment Short Form screening tool. Activities of daily living were assessed using the Barthel Index. [Results] The prevalence of sarcopenia at the time of admission was 47.2%. The Barthel Index and Mini Nutritional Assessment Short Form scores in patients with sarcopenia at the time of admission were significantly lower at discharge than to those in patients without sarcopenia. Overall, at discharge, weight and calf circumference decreased significantly with a consequent increase in the prevalence of sarcopenia (55.6%). Multivariate analysis showed that the Mini Nutritional Assessment Short Form score, calf circumference loss, and age affected the Barthel Index at discharge. [Conclusion] Patients with vertebral compression fractures often show sarcopenia and malnutrition, which are conditions that may be exacerbated during hospitalization. These conditions can subsequently affect a patient’s activities of daily living; thus, nutritional rehabilitation is important in patients with vertebral compression fractures, as demonstrated in this study.

Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature.

Skin ulcers (SU) are one of the most frequent manifestations of systemic sclerosis (SSc). SSc-SU are very painful, often persistent and recurrent; they may lead to marked impairment of patient's activities and quality of life. Despite their severe impact on the whole SSc patient's management, the proposed definition, classification criteria, and therapeutic strategies of SSc-SU are still controversial. The present study aimed to elaborate a comprehensive proposal of definition, classification, and therapeutic strategy of SSc-SU on the basis of our long-term single center experience along with a careful revision of the world literature on the same topic. A series of 282 SSc patients (254 females and 28 males; 84% with limited and 16% diffuse cutaneous SSc; mean age of 51.5±13.9SD at SSc onset; mean follow-up 5.8±4.6SDyears) enrolled during the last decade at our Rheumatology Unit were retrospectively evaluated with specific attention to SSc-SU. The SSc-SU were classified in 5 subtypes according to prominent pathogenetic mechanism(s) and localization, namely 1. digital ulcers (DU) of the hands or feet, 2. SU on bony prominence, 3. SU on calcinosis, 4. SU of lower limbs, and 5. DU presenting with gangrene. This latter is a very harmful evolution of both DU of the hands and feet needing a differential diagnosis with critical limb ischemia. During the follow up period, one or more episodes of SSc-SU were recorded in over half patients (156/282, 55%); skin lesions were often recurrent and difficult-to-heal because of local complications, mainly infections (67.3%), in some cases associated to osteomyelitis (19.2%), gangrene (16%), and/or amputation (11.5%). SSc-SU were significantly associated with lower patients' mean age at the disease onset (p=0.024), male gender (p=0.03), diffuse cutaneous subset (p=0.015), calcinosis (p=0.002), telangiectasia (p=0.008), melanodermia (p<0.001), abnormal PAPs (p=0.036), and/or altered inflammation reactant (CRP, p=0.001). Therapeutic strategy of SSc-SU included both systemic and local pharmacological treatments with particular attention to complicating infections and chronic/procedural pain, as well as a number of non-pharmacological measures. Integrated local treatments were often decisive for the SSc-SU healing; they were mainly based on the wound bed preparation principles that are summarized in the acronym TIME (necrotic Tissue, Infection/Inflammation, Moisture balance, and Epithelization). The updated review of the literature focusing on this challenging issue was analyzed in comparison with our experience. The recent advancement of knowledge and management strategies of SSc-SU achieved during the last years lead to the clear-cut improvement of patients' quality of life and reduced long-term disability.