Improvement In Activities Of Daily Living Research Articles

Occupational therapy for cognitive impairment in stroke patients

Cognitive impairment is a frequent consequence of stroke and can impact on a person's ability to perform everyday activities. There are a number of different intervention strategies that occupational therapists may use when working with people who have cognitive impairment post-stroke. To determine whether occupational therapy improves functional performance of basic activities of daily living (ADL) and specific cognitive abilities in people who have cognitive impairment following a stroke. We searched the Cochrane Stroke Group Trials Register (last searched May 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to April 2009), PsycINFO (1840 to April 2009), PsycBITE, OTseeker and Dissertation Abstracts (the latest three were searched up to April 2009). In an effort to identify further published, unpublished, and ongoing trials, we also tracked relevant references through the cited reference search in Science Citation Index (SCI) and Social Science Citation Index (SSCI), reviewed the reference lists of relevant studies and reviews, handsearched relevant occupational therapy journals, and contacted key researchers in the area. Randomised and quasi-randomised controlled trials that evaluated an intervention focused on providing cognitive retraining to adults with clinically defined stroke and confirmed cognitive impairment. The intervention needed either to be provided by an occupational therapist or given under the supervision of an occupational therapist. Two review authors independently examined the abstracts that might meet the inclusion criteria, assessed the quality and extracted data. We have presented results using mean differences. We included one trial with 33 participants in this review. We found no difference between groups for the two relevant outcomes that were measured: improvement in time judgement skills and improvement in basic ADLs on the Barthel Index. The effectiveness of occupational therapy for cognitive impairment post-stroke remains unclear. The potential benefits of cognitive retraining delivered as part of occupational therapy on improving basic daily activity function or specific cognitive abilities, or both, of people who have had a stroke cannot be supported or refuted by the evidence included in this review. More research is required.

Impact of estradiol valerate/dienogest (E 2V/DNG) on work productivity (WP) and activities of daily living (ADL) impairment in North American women with heavy and/or prolonged menstrual bleeding (HPMB)

OBJECTIVE: To estimate the impact of HPMB on WP and ADL impairment and improvements in these outcomes during E2V/DNG treatment over 7 cycles. DESIGN: This was a post-hoc analysis of patient-reported outcomes collected in a randomized, placebo-controlled trial conducted in the USA/Canada (Jensen JT, et al. Fertil Steril 2009;92(3):S32 [abstr. O-107]) that evaluated the efficacy of E2V/DNG in women with HPMB. The primary endpoint was a responder analysis that included reductions in menstrual blood loss (MBL). The response rate was significantly higher in E2V/DNG versus placebo recipients. MBL was reduced by –353.1 and –130.4 mL in E2V/DNG and placebo recipients, respectively, over a 90-day efficacy interval. MATERIALS AND METHODS: Data were collected using a modified Work Productivity and Activities Impairment (mWPAI) questionnaire. WP and ADL were measured at baseline and at treatment end (EOT) using a 10-point Likert scale (higher values=higher impairment). Analyses were done using frequentist and Bayesian multivariate regression. RESULTS: E2V/DNG had a positive impact on WP and ADL impairment.Tabled 1Mean mWPAI scale (SD)Difference E2V/DNG–placeboChange from baselineWP impairmentUSABaseline4.1 (.2)EOTPlacebo3.6 (.4)–13.1%E2V/DNG2.2 (.2)–38.1%–46.2%CanadaBaseline4.0 (.5)EOTPlacebo3.3 (.5)–16.1%E2V/DNG2.1 (.3)–37.2%–47.3%ADL impairmentUSABaseline5.1 (.2)EOTPlacebo3.8 (.4)–24.8%E2V/DNG2.4 (.2)–37.6%–53.0%CanadaBaseline4.6 (.5)EOTPlacebo3.3 (.5)–28.0%E2V/DNG2.0 (.2)–39.2%–56.2%According to the WPAI scoring manual and average salaries in the USA/Canada, E2V/DNG was associated with monthly per-person savings of US$80.20/CA$70.80 (WP) and US$84.90/CA$73.50 (ADL). Open table in a new tab According to the WPAI scoring manual and average salaries in the USA/Canada, E2V/DNG was associated with monthly per-person savings of US$80.20/CA$70.80 (WP) and US$84.90/CA$73.50 (ADL). CONCLUSION: As well as resolving clinical HPMB symptoms, E2V/DNG has a substantial positive effect on patient-reported outcomes. At EOT, E2V/DNG recipients showed a strong reduction in WP and ADL impairment versus baseline that was greater than that in placebo recipients.

Rivastigmine in the Treatment of Dementia Associated with Parkinson’s Disease: Effects on Activities of Daily Living

Aims: To investigate the effects of rivastigmine capsule 3–12 mg/day over 24 weeks on activities of daily living (ADLs) in patients with dementia associated with Parkinson’s disease (PDD). Methods: Post hocanalysis of a prospective, multicenter, randomized, double-blind, placebo-controlled trial in patients with PDD (≧50 years) randomized to rivastigmine 3–12 mg/day (capsules bid) or placebo over 24 weeks. This analysis was carried out with three subscales derived from a factor analysis of the 23 items in the Alzheimer’s Disease Cooperative Study – Activities of Daily Living (ADCS-ADL) scale. These subscales were basic ADLs (10 items), high-level function ADLs (eight items) and autonomy ADLs (five items). Results: 541 patients were randomized (362 to rivastigmine, 179 to placebo) and 410 (75.8%) completed the study. Rivastigmine was associated with significantly better outcomes in basic ADLs (–0.5 ± 6.19 vs. –1.7 ± 5.46; p = 0.025; effect size 22.1%) and high-level function ADLs (0.1 ± 4.95 vs. –1.0 ± 4.49; p = 0.017; effect size 22.9%) compared with placebo, at week 24. Conclusion: In patients with PDD, treatment with rivastigmine may show beneficial effects on overall ADLs, as well as modest, statistically significant improvements in basic ADLs and high-level function ADLs.

Examining Heterogeneity of Functional Recovery Among Older Adults With Hip Fractures

To examine heterogeneity in 1-year functional recovery following postacute rehabilitation among older adults with hip fracture. Two hundred twenty-five community-dwelling older adults with hip fracture who received postacute rehabilitation in 5 rehabilitation facilities in Baltimore, Maryland, were recruited during postacute rehabilitation (baseline) and follow-up at 2, 6, and 12 months following postacute rehabilitation discharge. Functional recovery was measured by the activities of daily living (ADL) and instrumental activities of daily living (IADL) scores. A mixed-effect model was used to examine factors associated with postacute rehabilitation functional recovery; fixed and random effects estimates from the models were used to demonstrate heterogeneity in functional recovery. Results indicated that there was an overall trend in both ADL and IADL functional improvement at 2 months following postacute rehabilitation, with continued improvement to 6 months, after which functional recovery slowed down and remained constant through the year. Individuals whose functional recovery did not conform to these patterns were identified and their functional recovery that deviated substantially from the group mean was demonstrated. Functional recovery patterns in elderly hip fracture patients are heterogeneous. To foster functional independence, health care professionals should consider individual recovery trajectories using a modeling approach appropriate for longitudinal or repeated measurement data such as a linear mixed-effects model when designing individualized rehabilitation and postacute rehabilitation care plans.

Association of Ability to Rise from Bed with Improvement of Functional Limitation and Activities of Daily Living in Hemiplegic Inpatients with Stroke: a Prospective Cohort Study

[Purpose] The purpose of this study was to investigate the association of ability to rise from bed with improvement in functional limitations and activities of daily living (ADL) in hemiplegic inpatients with stroke. [Subjects] Participants were 38 hemiplegic inpatients with stroke in a convalescence rehabilitation unit. [Methods] On admission, a newly developed assessment, rising from bed independence score (RIS) and rise from bed time (RBT) were measured. On discharge, the Berg Balance Scale, Functional Movement Scale, and Functional Independence Measure were measured. We calculated correlation coefficients between ability to rise from bed on admission and these traditional measures on discharge. The proportion of subjects who regained independent gait was calculated among subjects whose RIS was 7 on admission. [Results] RIS and RBT were significantly correlated with most of the traditional measures on discharge. Only RIS was significantly correlated with relative gain. Of those with RIS=7 on admission, 76.9% regained independent gait. [Conclusion] We found that ability to rise from bed of inpatients with stroke was associated with improvement of functional limitation and ADL in a convalescence rehabilitation unit. Ability to rise from bed on admission was a useful predictor of independent gait on discharge.

Comparative evaluation of four therapeutic regimes in chikungunya arthritis: a prospective randomized parallel-group study

Objective To evolve a treatment protocol for patients presenting in acute stage of chikungunya by identifying the best regimen from four treatment regimes. Materials and methods One hundred and twenty patients diagnosed to have chikungunya arthritis clinically were randomized to one of four groups receiving combinations of aceclofenac (200 mg/day), hydroxychloroquine (400 mg/day) and prednisolone (10 mg/day). Group A received aceclofenac alone; Group B received aceclofenac plus hydroxychloroquine; Group C received aceclofenac and prednisolone and Group D, all three agents. Study medications were given for 6 weeks with weekly follow-ups followed by a 6 weeks drug-free follow-up with visits at week 8 and week 12. Efficacy variables including visual analog scale (VAS) for pain, 20-point modified Barthel index for activities of daily living (ADL) and instrumental activities of daily living (IADL) were assessed and recorded during start of therapy and at all follow-up visits. Results Significant ( P < 0.001) reduction in VAS scores and improvement in ADL and IADL scores were observed in groups C and D compared to groups A and B. Between groups A and B there was no significant difference; similarly, between groups C and D also there was no significant difference. Conclusion Addition of prednisolone, and not hydroxychloroquine, to aceclofenac reduced pain and improved the quality of life in patients with acute chikungunya arthritis, compared to aceclofenac given alone in the management of early chikungunya fever. We propose a combination of non-steroidal anti-inflammatory drugs with corticosteroid as the best regimen in treating acute chikungunya cases with arthralgia.

The Effect of Bilateral Total Knee Arthroplasty (TKA) in a Stroke Patient with Hemiplegia and Knee Osteoarthritis

This is a case report evaluating the improvement of activities of daily living (ADL) after TKA in stroke patient with hemiplegia and knee osteoarthritis. The case was a 73-year-old female with left hemiplegia caused by cerebral infarction. She also suffered from severe bilateral knee osteoarthritis and obesity. The hemiplegia and knee dysfunction disturbed her ADL. When she was admitted to our hospital, her FIM motor subscore was 23 and body mass index (BMI) was 36.0. She went on a diet and continued rehabilitation. Her knees were treated conservatively. Six months after the stroke, her FIM motor subscore was 35 and BMI was 29.8. For the purpose of pain relief and improvement of range of motion, right TKA was performed seven months after stroke. And left TKA and lengthening of the gastrocnemius were performed eleven months after her stroke. Rehabilitation was continued carefully in order to avoid deep venous thrombosis. In addition, a left obturator nerve block was performed as treatment for spasticity of her hip adductor muscle. Fifteen months after the stroke, her FIM motor subscore was 77 and BMI was 25.7. TKA is a common treatment for osteoarthritis but when a patient has a stroke, it is difficult to determine whether to perform surgery or not. In this case, bilateral TKA achieved improvement of ADL. We suggest that even if a patient has stroke hemiplegia, TKA should be considered for knee osteoarthritis based on the appropriate assessment and careful risk management.

Effect of promote resuscitation acupuncture combined wtth rehabilitation training on motor function after stroke

Objective To eompare the difference between promote resuscitation acupuncture combined with rehabilitation training and single application in treatment of patients with stroke. The effect of improving the activities of daily living (ADL) of motor function also be assessed. Methods 90 stroke patients were randomly divided into treatment group(n =30),control group Ⅰ(n =30),and control group Ⅱ(n =30). Promote resuscitation acupuncture was applied in the control group Ⅰ,rehabilitation training was applied in the control group Ⅱ,and combination of the two methods in the treatment group. Fugl-Meyer Assessment(FMA) and Bartbel index were used for evaluation of the results. Results The total rate of effectiveness is 90.0% for the treatment group,66.7 % for the eontrol group Ⅰ, and 63.3% for the control group Ⅱ. There were significant differences between the treatment group and the control group Ⅰ and between the treatment group and the control group Ⅱ( P 0.05 ). Conclu-sion Promote resuscitation acupuncture combined with rehabilitation training is signifieantly effective in improvement of motor function and ADL of stroke patients. Key words: Cerrbrvasetdar Accident; Hemiplegia; Rehabilitation; Aeupunture therapy

Cost-effectiveness of percutaneous vertebroplasty in osteoporotic vertebral fractures

A retrospective study was conducted in 179 consecutive patients (48 males, 131 females; mean age: 72.0 +/- 8.59 years; range: 51-93) with single symptomatic acute amyelic osteoporotic vertebral fracture presenting between September 2004 and September 2005 to the Santa Lucia Foundation in Rome, Italy. Vertebral fractures usually become manifest due to pain which can be debilitating. Treatment depends on the presence or absence of spinal cord involvement. In the first case, surgical stabilization is mandatory. In the second case, treatment may be performed either by conservative medical therapy (CMT) or percutaneous vertebroplasty (PVT). The aim of this study was to evaluate the effectiveness, costs and cost-effectiveness of percutaneous vertebroplasty. After 2 weeks of analgesic therapy, 153 patients presented refractory pain and were offered treatment by PVT. A total of 58 patients accepted and underwent PVT (PVT group), while 95 refused and underwent conservative medical therapy (CMT group). Follow-up was performed by specialist consults, spine radiography and MRI and a self-assessment questionnaire evaluating pain using a Visual Analogue Scale (VAS) and function using an ambulation and an Activities of Daily Living (ADL) scale. A 12-month follow-up was obtained in 86 of 95 (90.5%) CMT group patients and 54 of 58 (93.1%) PVT group patients. Significant reduction of VAS and improvement of ambulation and ADL was observed in both groups at 1 week and 3 and 12 months (P < 0.05; Wilcoxon signed rank test), however, these results were significantly superior in the PVT group at 1 week and 3 months (P < 0.05; Mann-Whitney U test). Average cost per patient at 1 week and 3 and 12 months were respectively 755.49 +/- 661.96, 3791.95 +/- 3341.97 and 4299.55 +/- 3211.53 euros (CMT group) and 3311.35 +/- 0.32, 3745.30 +/- 3.59 and 4101.05 +/- 755.41 euros (PVT group). PVT resulted significantly more cost-effective than CMT with regards to the three scales at 1 week (P < 0.05; Mann-Whitney U test). At 3 months PVT was more cost-effective than CMT with regards to the three scales, however, the difference was significant only with regards to ambulation. No significant differences in cost-effectiveness where found between the two groups at 12 months. PVT should be considered the treatment of first choice in symptomatic acute amyelic osteoporotic vertebral fractures with refractory pain after a short period of analgesic therapy.

Long-term effect of deep brain stimulation for essential tremor on activities of daily living and health-related quality of life

To report long-term effects of thalamic deep brain stimulation (DBS) on activities of daily living (ADL) and health-related quality of life (HRQoL) in patients with essential tremor (ET). Nineteen consecutive patients were evaluated at baseline, at a mean of 1 year, then at a mean of 7 years after DBS using Tremor Rating Scale, Mini Mental Test, ADL Taxonomy, Nottingham Health Profile, Life Satisfaction Checklist, Visual Analogue Scale and interview. There was a decrease of DBS efficacy on tremor between 1 and 7 years post-operatively. The marked improvement in ADL at 1 year was no longer sustained at long-term, except for the ability to eat. Social life remained improved. Although there is a decrease of DBS effect on tremor at 7 years, and even though further ageing and co-morbidities may impact on the well-being of patients, there is still relevant benefit of DBS on few aspects of ADL and HRQoL in patients with ET.

Changes in activities of daily living during treatment of late‐life depression*

AbstractBackground: Patients with late‐life depression often exhibit cognitive deficits or disability. The relationship between late‐life depression and disability is an area of significance for geriatric psychiatry. The purpose of the present study was to investigate the association between changes in the severity of depression and activities of daily living (ADL) during treatment of late‐life depression.Methods: We examined the severity of depression, cognitive function and ADL among 70 subjects aged 65 years or older with a history or a current episode of major depression. Examination with the Hamilton Depression Rating Scale (Ham‐D), the Mini‐Mental State Examination (MMSE), the Barthel Index (BI) and the Hyogo Activities of Daily Living Scale (HADLS) were performed twice at an interval of approximately 1 month. All patients were receiving drug therapy for their depression.Results: Participants presented with varied depressive severity on the Ham‐D and a slight cognitive deficit on the MMSE; approximately 60% had at least one problem on the HADLS. Between baseline and the follow‐up examination, significant improvements were noted in Ham‐D, MMSE and HADLS scores, but not the BI score. The correlations between the Ham‐D and ADL scores were significant at baseline and at the follow up examinations. In a multiple regression analysis, the difference in follow‐up and baseline scores on the Ham‐D contributed significantly to that of HADLS.Conclusions: The present study demonstrates that many patients with late‐life depression have some problems with ADL and that a substantial improvement in ADL occurs in association with temporal improvement of depressive severity among subjects with late‐life depression.

Effects of Anemia on the Rehabilitation Outcomes in Elderly Patients in the Post-Acute Care Setting.

Background - More than 3 million people in the United States over the age of 65 are anemic. The evidence indicates that older people with anemia suffer hospitalizations, physical decline and disability more than people without anemia. Additionally there are reports that anemia is an independent risk factor for this decline in physical performance in those over the age of 65.Objective - The goal of this study was to detail if anemia significantly affects patient's rehabilitation outcomes by focusing on the ability to perform activities of daily living (ADL) as assessed by the physical therapist, the disposition upon discharge (meeting the therapy goals) and an analysis of length of stay (LOS) in relation to anemia.Methods - We conducted a chart review of 260 medical records of patients who underwent rehabilitation therapy at the North Chicago Veterans Affairs Medical Center, and detailed the progress of 69 of these patients who received ADL therapy. The study is ongoing with a projected chart review of 437 medical records, and with an estimated final sample size of 150. Univariate and multivariate analysis was conducted in relation to our outcome measures.Results - The anemic group had 43 patients and the non-anemic 26. Average values for anemic patients were: Hgb 11 Hct 32, MCV 88, MCH 29.2, RDW 15.6, Platelets 259, the non-anemic patients values were: Hgb 13.4, Hct 39, MCV 89, MCH 33.3, RDW 14.3, platelets 229. The patients with anemia had a median change in ADL scores of 9 versus non-anemic patients' median change in scores of 12 (p=0.154). Length of stay was 51 days (median) for anemic patients and 36 days (median) for non-anemic patients (p=0.108) Of the non-anemic patients, 19 out of 26 (73%) met the goals of therapy and 21 out of 43 (49%) of the anemic patients met the goals of therapy (p=0.055). Surprisingly, only 3 out of the 43 (7%) anemic patients were treated for their anemia or had work up done to identify the cause of the anemia. The multivariate model for length of stay indicated that anemia was not significant (p=0.842), the morbidity of the patient was marginally not significant (p=0.089), however, the patients' age was statistically significant at p=0.05. For the multivariate model of ADL improvement the results were: anemia p=0.186, sex p=0.298, Charlson index p=0.50.Conclusion - There is a definite lack in the identification and treatment of anemia in patients undergoing rehabilitation. Anemia exerts an influence on the course of patient therapy/recovery and should be addressed as an individual problem. Anemic patients undergoing rehabilitation are scoring lower, and are admitted longer to the hospital.

Neurological effects of high-dose idebenone in patients with Friedreich's ataxia: a randomised, placebo-controlled trial

Friedreich's ataxia (FA) is a progressive, multisystem, degenerative disorder caused by a reduction in frataxin. Loss of frataxin results in mitochondrial dysfunction and oxidative damage in patients and model systems. Previous studies have indicated that the antioxidant idebenone (5 mg/kg daily) reduces cardiac hypertrophy, but definite improvement in neurological function has not been shown. 48 genetically confirmed FA patients, aged 9-17 years, were enrolled in a 6-month, randomised, double-blind, placebo-controlled study. The patients received placebo or one of three doses of idebenone (approximately 5 mg/kg, 15 mg/kg, and 45 mg/kg), stratified by body weight. The primary endpoint was change from baseline in urinary 8-hydroxy-2'-deoxyguanosine (8OH2'dG), a marker of oxidative DNA damage. Secondary endpoints included changes in the international cooperative ataxia rating scale (ICARS), the FA rating scale (FARS), and a survey of activities of daily living (ADL). This study is registered with ClinicalTrials.gov, number NCT00229632. Idebenone was generally well tolerated with similar numbers of adverse events in each group. One child receiving high-dose idebenone developed neutropenia after 6 months, which resolved after discontinuation of treatment. 8OH2'dG concentrations were not increased, and did not significantly change with idebenone treatment. Whereas an overall analysis did not show a significant difference in ICARS, FARS, or ADL total scores, there were indications of a dose-dependent response in the ICARS score. A second, pre-specified analysis, excluding patients who required wheelchair assistance, showed a significant improvement in ICARS (Bonferroni p=0.03) and suggested a dose-related response in ICARS, FARS, and ADL scores. Treatment with higher doses of idebenone was generally well tolerated and associated with improvement in neurological function and ADL in patients with FA. The degree of improvement correlated with the dose of idebenone, suggesting that higher doses may be necessary to have a beneficial effect on neurological function.

Mitigating functional performance decrement in cancer patients undergoing treatment

9105 Background: It is well-documented that treatment side-effects cause physical and psychosocial de-conditioning in cancer patient. Decrease in functional performance (FP), as measured by activities of daily living (ADL), is a major contributor to a decline in patient quality of life (QOL). Relatively little information is available on the effects of a specific exercise regimen targeting muscle groups/energy systems involved in FP. Methods: 30 male and female cancer patients receiving treatment were randomly assigned to either the experimental (EX) or control (C) groups. EX participated in two exercise sessions per week for 17 weeks. Sessions included a combination of aerobic, resistance, flexibility, and balance training. C did not participate in any structured exercise. Data were collected post-diagnosis (1), post- surgery (2), at 9 weeks post-diagnosis (3), and at 17 weeks post-diagnosis (4). Measurements included resting heart rate (RHR), fatigue, physical activity level (PA), QOL, and the FP tasks of: treadmill walking (TRED), stair climb/descent (STAIR), lifting/carrying (CARRY), sit to stand (STAND), and balance (REACH). Results: Factor analysis yielded four variables: FP1 = [(0.5 × TRED) - (0.5 × RHR)]; FP2 = [(STAIR) + (CARRY) + (STAND)]/3]; FP3 = [(0.333 × QOL) + (0.333 × PA) - (0.333 × FT)]; FP4 = REACH. Repeated-measures ANOVA with within-subjects contrasts detected significant differences between groups. No significant differences existed at 1 or from 1 to 2. Significant differences were found on all variables from 1 to 4, 1 to 3 and 3 to 4 (p &lt; 0.001) (significant improvement for experimental group vs. significant decline for control group). Mean changes for the experimental vs. control groups from 1 to 4 are as follows: FP1 (+65.5 vs. -29.5); FP2 (-5.3 vs. +3.6); FP3 (+1.8 vs. -3.4); FP4 (+1.7 vs. -0.81). Conclusions: Specifically-designed exercise interventions promote positive adaptations that elicit significant improvement in ADL, QOL, and decrease fatigue. Prescriptive exercise is a viable therapy during treatment for mitigating side effects and avoiding de-conditioning. No significant financial relationships to disclose.

介護老人保健施設における感染症と耐性菌 （2）耐性菌をもつ微熱患者と尿路感染症患者への対応

Elderly patients living in nursing homes can easily find themselves unable to carry out their daily activities, once they become ill, even with infectious diseases of a slight to mild degree, and rapid treatment is required to cure them of their malaise. However, treatment is often difficult due to the presence of drug-resistant bacteria. This study was designed to evaluate the efficacy of the selective use of antimicrobial agents based on a sensitivity test of isolated bacteria. Possible pathogenic bacteria were isolated from cultures of pharyngeal swabs or urine obtained from patients with chronic febrile conditions or urinary tract infections, resistant to antimicrobial treatment. The efficacy of the treatment was evaluated based on release from febrile conditions and improvement of activities of daily living (ADL) accompanied by the disappearance of possible pathogenic bacteria following the use of selective antimicrobial agents. The outcome of 14 cases with sustaining febrile conditions and 3 cases with urinary tract infections was reviewed. Most of them showed a good response to treatment with remarkable improvement in ADL. In some cases, patients were switched from one antimicrobial agent to another each time new pathogenic bacteria were detected in the culture. A combination of rifampicin and sulfamethoxazole/trimethoprim (RFP/ST) was found to be the most convenient and effective treatment in patients with MRSA or drug-resistant Streptococcus pneumoniae. Levofloxacin (LVFX)-resistant Escherichia coli were detected together with MRSA in our 3 patients with urinary tract infections, corresponding to the frequent use of LVFX in our community. Identification of possible pathogenic bacteria and the use of proper antibiotic agents based on a sensitivity test are very effective in the treatment of elderly patients with chronic febrile conditions arising from the presence of drug-resistant bacteria. Careful use of fluoroquinolones is required in patients in whom MRSA is or had once been detected. This is beneficial not only for the elderly patients themselves but is also useful in preventing the spread of drug-resistant bacteria.

Treatment Effects of Antidepressants in Patients with Post-Stroke Depression: A Meta-Analysis

Appropriate treatment of post-stroke depression (PSD) is critically important, considering the negative impact of PSD. Data regarding the treatment efficacy of antidepressants in patients with PSD are conflicting, and the time-dependent effects of antidepressant treatment in this population are unknown. To systematically assess treatment effects of antidepressants in patients with PSD, incorporating data from recent studies. A meta-analysis of randomized placebo-controlled trials (RCTs) of antidepressants in patients with PSD was conducted, using published studies from 1984 to 2006. Outcome measures of antidepressant treatment included response rate, depression rating scale scores, recovery of neurologic impairments, and improvements in activities of daily living (ADLs) after stroke. The effect size was presented as rate difference (RD) and weighted mean difference for dichotomous outcomes and continuous outcomes, respectively. Pooled effect sizes were calculated by both fixed-effects and random-effects models. A total of 1320 patients who met inclusion criteria were identified from 16 RCTs. The pooled response rates in the active and placebo groups were 65.18% (234/359) and 44.37% (138/311), respectively. The pooled RD was 0.23 (95% CI 0.03 to 0.43), indicating a significantly higher response rate in the active group compared with the placebo group. From baseline to endpoint, patients in the active group had significantly greater improvement in depressive symptoms compared with patients in the placebo group. Longer duration of treatment was positively correlated with the degree of improvement in depressive symptoms (Spearman's correlation, [rho] = -0.93, p = 0.001). No consistent evidence was found for positive antidepressant effects on the recovery of neurologic impairments and improvements in ADLs. The results of this meta-analysis suggest that use of antidepressants among patients with a diagnosis of PSD is associated with improvement in depressive symptoms. Longer durations of antidepressant treatment may be associated with greater reductions in depressive symptoms.

Bilateral Video-Assisted Thoracoscopic Thymectomy vs. Extended Transsternal Thymectomy in Myasthenia Gravis: A Prospective Study

The optimal approach to thymectomy remains controversial. This study is designed to prospectively compare the results between bilateral video-assisted thoracoscopic thymectomy (BVTx) and extended transsternal thymectomy (ETTx) in patients with myasthenia gravis (MG) without thymoma. Fifteen patients who had undergone BVTx and 16 patients who had undergone ETTx were compared for age, gender, severity of disease, preoperative duration of disease, operative time, intraoperative blood loss, postoperative complications, hospital stay, duration of chest tube drainage, thymic histopathology, pain perception by visual analog scale (VAS), remission and improvement rate, period of follow-up, and activities of daily living (ADL). Fisher’s exact test, t test and paired t test were used for statistical analysis. BVTx had longer operative time and less intraoperative blood loss than that of the ETTx. Their remission rates and their degree of postoperative ADL improvement were not significantly different. However, the lowering of VAS was significantly greater in the sternotomy group at 3 months. All other parameters were not significantly different. No mortality was noted in the series. We consider BVTx as an effective alternative procedure to the transsternal approach for patients with nonthymomatous MG. As more and more people care about cosmetics, BVTx could become the future trend.

Cross-functional team processes and patient functional improvement.

To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study

The investigation aimed at determining the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee by conducting a randomized, double-blind, placebo-controlled clinical trial. The trial consisted of 2h daily treatment 5 days per week for 6 weeks in 83 patients with knee OA. Patient evaluations were done at baseline and after 2 and 6 weeks of treatment. A follow-up evaluation was done 6 weeks after treatment. Activities of daily living (ADL), pain and stiffness were evaluated using the Western Ontario and McMaster Universities (WOMAC) questionnaire. Within group analysis revealed a significant improvement in ADL, stiffness and pain in the PEMF-treated group at all evaluations. In the control group there was no effect on ADL after 2 weeks and a weak significance was seen after 6 and 12 weeks. Significant effects were seen on pain at all evaluations and on stiffness after 6 and 12 weeks. Between group analysis did not reveal significant improvements over time. Analysis of ADL score for the PEMF-treated group revealed a significant correlation between less improvement and increasing age. Analysis of patients <65 years using between group analysis revealed a significant improvement for stiffness on treated knee after 2 weeks, but this effect was not observed for ADL and pain. Applying between group analysis we were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee OA in all patients. However, in patients <65 years of age there is significant and beneficial effect of treatment related to stiffness.

The impact of discharge to a care home on longer term stroke outcomes

To examine the impact of discharge to a care home on the longer term recovery after stroke. An uncontrolled naturalistic study of stroke survivors, matched for stroke severity, discharged from a stroke rehabilitation unit to either a care home (n = 65) or to their own home (n = 65). Stroke-related variables were assessed in both groups shortly before discharge and again at six months after discharge. A stroke rehabilitation unit, care homes in the community and subjects' own homes. Functional activities of daily living (ADL), cognitive function, depression, health service utilization, health-related quality of life. Despite low levels of rehabilitation in both groups, at six months subjects discharged home had a better functional improvement in ADL (Barthel score 14.9 compared with 10.8) and health-related quality of life (HRQoL) (five-item EuroQol score 0.60 compared with 0.35). Poorer outcome in subjects discharged to care homes may be remediable and could respond to better rehabilitative efforts and increased social support and encouragement for this group of stroke survivors.