Daily Activities Of Patients Research Articles

Modern methods of treating sleep disorders in patients with Parkinson’s disease and previous radiation exposure

Relevance. Sleeplessness is a non-motor disorder that reduces the daily activity of patients with Parkinson’s disease.Intention. To evaluate the effectiveness of the drug “Melaxen” (melatonin) in the treatment of patients with sleep disorders and daytime sleepiness in patients with Parkinson’s disease and previous radiation exposure.Methodology. Fifty patients with Parkinson’s disease (Stage I–II according to Hen-Yar, duration of 3.5 to 6.5 years), previous radiation exposure and current sleep disorders were examined. On average, patients aged (65.8 ± 5.8) years. Most of them were employees of various departments of the Russian Emercom and Defense Ministry. On average, 38 male patients spent (56.1 ± 27.0) days in the area of radiation exposure, with exposure dose of (21.4 ± 11.9) roentgen equivalent man (rem). Female patients-inhabitants of radiation contaminated areas most likely received mean effective dose of 9 mSv (0.9 rem) per person. During treatment of Parkinson’s disease with “Levodopa” in the average daily dosage of (562.5 ± 62.5) mg (stable dose after the start of melatonin), 39 (78 %) of them also received dopamine receptor agonists at a dose of (1.0 ± 0.25) mg / day, the drug Melaxen (melatonin) was used to correct sleep disordersfor over 28 days at a daily dose of 3 mg taken 30–40 minutes before sleep daily. The clinical and psychological state of the patients was studied twice before and after completion of the course of treatment using scales to study the quality and individual significance of sleep, the hospital anxiety and depression scale (HADS), certain cognitive tests and individual sleep diaries.Results and Discussion. According to the clinical and psychological tests, Melaxen (melatonin) contributed to improving the quality of sleep, mental well-being, activity, some cognitive functions, reducing daytime sleepiness and anxiety. The optimization of the mental state was also reflected in the personal diaries of sleep quality. A number of indicators only tended to improve, probably due to short-term studies.Conclusion. In patients with Parkinson’s disease, “Melaxen” was associaeted with improved sleep quality, decreased daytime sleepiness and severity of anxiety and depression, and also increased concentration.

Plasma exchange in patients with myocarditis: comparison study

Abstract Background Cardiac auto-antibodies (AABs) are detected frequently in patients with inflammatory dilated cardiomyopathy (iDCM) of arrhythmias due to myocarditis. Elimination of AABs with apheresis improves left ventricular function as well as the immunosuppressive drugs (ISDs) do. There is no data on the combined use of ISDs and apheresis. Aims To investigate the clinical efficiency of plasma exchange (PE) in patients with myocarditis in comparison with patients without PE. Methods There were 38 patients with iDCM under stable oral medication with maximal tolerated dose of β-blockers/angiotensin-converting enzyme inhibitor/aldosterone antagonists at least 3 month before study inclusion; and 48 patients with arrhythmias due to myocarditis resistant to antiarrhythmic drugs (AADs). Patients underwent evaluation including heart CT scan, MRI, endomyocardial biopsy, myocardial perfusion scan, and coronary angiography to diagnose myocarditis. All the patients had a high level of AABs against cardiac antigens. PE group were consisted of 19 patients with iDCM (left ventricular ejection fraction (LVEF) 35±7%) and 22 patients with arrhythmias (premature atrial (PACs) or ventricular (PVCs) contractions more than 3000/day or atrial fibrillation (AF)). All the patients in PE group underwent a single volume PE filled with 0.9% sodium chloride. Another 19 iDCM patients and 26 arrhythmic patients were controls without PE. Echocardiographic parameters, a 6-minute walk test (6MWT) distance, Holter monitoring and AABs level were assessed at baseline, 6 and 12 month follow-up. Some patients were treated by ISDs before PE. PE group patients got methylprednisolone (MP) significantly rare than controls after PE. The mean doses of MP were significantly lower than in controls too. Results AABs level significantly decreased just after PE and during the follow-up only in PE group. iDCM patients also had significant improvement in LVEF 35±7% vs. 45±11% at a year follow up, and 6MWT distance in comparison with LVEF 33±7% vs. 37±11% at a year follow up in controls. There were 58% PE group patients with absolute LVEF improvement >10% classified as responders in comparison with 32% responders in controls. There were 86% PE group patients with arrhythmias in and 58% patients in control group who were classified as responders as they achieved a decrease of PAVs and PVCs or AF frequency >75% relative to baseline. AADs were eliminated in 46% PE group patients and in 23% control group patients with arrhythmias. We also tried to predict good response for PE in both iDCM and arrhythmic patients. iDCM responders were characterized by LVEF≤37% at baseline. Arrhythmic group responders were characterized by higher level of AABs to cardiac conduction cells antigens at baseline. Conclusions PE improves both cardiac function and daily activities in patients with iDCM and arrhythmias due to myocarditis. PE is safe and high effective, and helps avoid using high doses of ISDs Funding Acknowledgement Type of funding source: None

Daily Activities: The Impact of COPD and Cognitive Dysfunction.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation; however, pulmonary function does not fully account for patients' functional difficulties. The primary aim of the study was to determine the association between several domains of cognition and daily activity among those with COPD. Eighty-nine former smokers completed a neuropsychological battery including measures across multiple domains of cognition, pulmonary function measures, and daily activity questionnaires. Using a cross-sectional design, we compared daily activity between former smokers with and without COPD using two measures (St. George's Respiratory Questionnaire [SGRQ] Activity Subscale and Lawton Instrumental Activities of Daily Living [IADL] Scale) and examined the association between cognition and daily activity among those with COPD. As expected, former smokers with COPD reported more difficulty than those without COPD on both activity measures (SGRQ Activity Subscale p<.001; Lawton IADL Scale p=.040). Among former smokers with COPD, poorer delayed recall was associated with more difficulty with daily activities (SGRQ Activity Subscale) (p=.038) while adjusting for severity of airflow limitation, exercise tolerance, oxygen use, dyspnea, and symptoms of anxiety and depression. The findings suggest that cognition is associated with daily activity in patients with COPD. Future research should examine whether cognitive interventions may help to maximize patients' engagement in daily activities.

Study in the Clinical Outcomes and Quality of Life in Epilepsy Patients at Bangkok Hospital Headquarters

OBJECTIVES: To evaluate clinical outcomes of care for patients with epilepsy (PWEs) and assess the quality of life (QOL) for PWEs in Epilepsy Clinic at Bangkok Hospital Headquarters (BHQ). MATERIALS AND METHODS: A cross-sectional descriptive study was conducted at the Epilepsy Clinic in a tertiary care private hospital. The study population included patients with epilepsy who are over 18 years of age. It took place from July 2016 to December 2018. The clinical outcomes were assessed by the frequency of seizures and QOL. The QOL was assessed by the Thai version of QOLIE-31-P questionnaire. It comprises 38 questions about patients’ health and the daily activities of patients with epilepsy. The Epilepsy Clinic’s compliance with the Epilepsy Quality Measurement set (EQMs) standard was used to evaluate the patient’s care process. Descriptive statistics were used in this study to determine compliance with quality measurements. A Fisher’s Exact Test was used to compare the seizure frequency between baseline and 12-week follow-up and a Paired t-test statistic was used to compare QOL scores among baseline and 12-week follow-up. RESULTS: A total of 66 participants were used in our survey study. 46 (69.7%) of them were female. The mean age was 35.18±12.52 years. The average age of the first seizure onset was 27.21±13.75 years. 49 (74.2%) had a duration of epilepsy of more than 5 years. 54 (81.8%) had a bachelor degree in education. 48 (72.7%) of etiology were unspecified. 63 (95.5%) had partial or focal seizures. 58 (87.9%) of seizure frequency had no seizure or had it once in the last 3 months. All participants did not have adverse effects from antiepileptic medications. All records had compliance rates with the EQMs standard of more than 60% up to 100%. The overall mean score of QOLIE-31-P in the participants at 12-week follow-up was at a relatively moderate level and the energy subscale was lowest, while the daily activities subscale was highest. The Mood, Energy subscales and final QOL scores of patients with epilepsy had statistically significant differences between baseline and 12-week follow-up (p &lt; 0.01). The seizure frequency indicated no significant differences between baseline and 12-week follow-up (p &lt; 0.05). CONCLUSION: Researchers suggested that the QOLIE-31-P questionnaire for screening should become a routine practice for QOL assessment in PWEs and detection for signs of psychiatric symptoms that worsen QOL. Seizure frequency may not be the only single factor that represents a complete valid index to evaluate clinical outcomes. The EQMs standard may be applied to practice as it can resolve the missing necessary clinical data or gaps in care that may be beneficial to improve PWE patient care outcomes.

Retinal nerve fiber layer changes in migraine: A protocol for systematic review and meta-analysis.

Background:Migraine is a common neurological disease, which seriously affects the quality of life and daily activities of patients. Although migraine is a transient phenomenon of cerebral vasoconstriction, it is well documented that recurrent attacks of migraine may lead to abnormalities in retinal structure. Optical coherence tomography (OCT) is a sensitive method to detect subtle damage in retinal nerve fiber layer (RNFL). There have been many studies investigating the difference in RNFL thickness with optical coherence tomography (OCT) between migraine patients and healthy controls. However, the results were not consistent. Our purpose is to perform a meta-analysis to investigate RNFL alterations in migraine.Methods:We will search PubMed, Embase, Web of science for studies assessing the differences in RNFL measured by OCT between patients with migraine and healthy controls. Case-control studies published in English will be included. Two reviewers will independently screen eligible articles, extract data, and assess quality. This meta-analysis will synthesize selected research data and compare the difference in RNFL thickness between patients with migraine and healthy controls. We will use Stata 15 in this meta-analysis. I2 statistics will be used to assess heterogeneity. If I2 ≤ 50%, the data are synthesized will use a fixed effect model. Otherwise, a random effect model will be performed. Publication bias will be determined by the Egger test. The methodological quality of all included studies will be evaluated by the Newcastle-Ottawa Scale (NOS). We will perform subgroup analysis, sensitivity analysis, and meta-regression analysis to test the robustness of the results.Results:We will obtain quantitative results regarding the difference in RNFL thickness between migraine patients and healthy controls. The results will be published in a peer-reviewed journal.Conclusions:The results of this study provide a high-quality synthesis of existing evidence and provide a basis for assessing the effect of migraine on the thickness of RNFL.Registration number:INPLASY 202060033

Chronic axonal idiopathic polyneuropathy: is it really benign.

Chronic idiopathic axonal polyneuropathy (CIAP), a common neurological condition, is considered to be a benign neurological condition with a small risk of disability. However, many studies have shown a reduced quality of life and a nonnegligible affection of daily activities in patients with CIAP. Here we summarize recent data about CIAP. We discuss some of the latest articles regarding risk factors, comorbidities, and possible pathogenic factors regarding CIAP. Patients with chronic polyneuropathy have impaired walking capacity, disturbed balance, and an increased risk of falls. Idiopathic polyneuropathy has a negative impact on activities of daily living. Patients with CIAP may develop plantar ulcers and neuropathic arthropathy. Small fiber involvement may occur, and two recent studies indicate that neuropathic pain is present in about two thirds of the CIAP group. Furthermore, patients with CIAP with neuropathic pain have increased fatigue and poorer emotional well being. Despite the relatively mild motor impairment seen in most patients with CIAP, the condition causes limitations in life with decreased mobility, pain, and affection of basal daily activities. Because the pathogenesis of CIAP in unclear, there is no disease modifying treatment. Further studies regarding pathogenesis, and randomized controlled clinical trials regarding possible treatment options are needed.

Health-related quality of life in patients with narcolepsy types 1 and 2 from a Sleep Center in Brazil.

Narcolepsy patients have higher prevalence of comorbidities, such as obesity, depression, and pain. Narcolepsy symptoms and concomitant medical conditions can impact the daily activities of patients. The objective of this study is to describe the quality of life in a sample of patients with narcolepsy, and the influence of the nutritional status in health domains. At Unifesp, two groups of 33 patients (narcolepsy types 1 and 2 meeting 2014 criteria, concerning hypocretin-1) and 33 controls without sleepiness, matched by age and sex, filled out the SF-36. Narcolepsy groups, regardless of their nutritional status, had significantly lower scores in all domains, compared to controls, mainly in Role-physical, Role-emotional, and Energy/Fatigue. Role-physical score was lower in type 1 than in type 2 and controls (37.8±1.0 vs. 50.0±1.2 vs. 85.6±1.6; p<0.0001). Obese with type 2 narcolepsy scored lower than type 1 in physical scales. In a Sleep Center in São Paulo, Brazil, physical and mental health were impaired in narcolepsy types 1 and 2. The first report of the poor health status in Brazilians with narcolepsy type 2 suggests that obesity negatively affects physical domains.

Management of Postpartum Mothers with After Pain at the Clinic

Post partum is a period of 1-2 months after the delivery of the placenta until the uterus returns to normal. Post partum will issue lochea which comes out along with the birth of the placenta. Patients will experience complaints that will be felt in the postpartum, namely complaints of heartburn which helps the uterus to return to its shape normal. And these complaints will interfere with the patient's daily activities, namely irregular sleep patterns, feeling tired, feeling anxious. This discomfort was experienced by Mrs. A 21 years old, with 37 weeks of age complaining of stomach cramps or after pain, an assessment of these complaints has been made. And the results of the study, evaluation, and progress notes. Data has been collected by assessment, physical examination, diagnosis, and documentation by comparing the results of the data with the theory. And these complaints are normal complaints that are felt by every post partum mother. Contractions will cause different pains, namely mild, moderate, even severe pain

Clinical variety of affective, sleep and motor manifestations in craniocervical dystonia (a literature review)

Recent research data literature indicates the presence of non-motor symptoms in patients with dystonia such as mood disorders, cognitive impairments, sleep disturbances, autonomic dysfunction and / or pain, which are important components of quality of life. The article discusses possible comorbidity of affective manifestations,sleep disorders and dystonia. Currently, evidence is controversial, and the question requires further study. Affective symptoms and sleep disturbances of dystonia are now recognized as the greater determinant of quality of life in dystonia, being associated with health and disability, although their contribution to the clinical picture of the disease often remains underestimated. It becomes important to identify these manifestations, assess their severity and impact on the daily activity of patients with craniocervical dystonia.

Nerve Injuries in Hip and Knee Arthroplasty - Risk Factors, Diagnostic and Therapeutic Approaches

Iatrogenic nerve injuries are rare complications of total hip and knee arthroplasty, which may cause chronic pain and loss of function, severely affecting the patient's daily activities and quality of life. Nerves "at risk" include the sciatic nerve, the femoral nerve, the lateral femoral cutaneous nerve and the superior gluteal nerve during total hip arthroplasty, and the infrapatellar branch of the saphenous nerve as well as the peroneal nerve during total knee arthroplasty. Multiple procedure-related and patient-related factors have been identified to modify the risk of nerve injury in the course of lower limb joint replacement surgery. These include the surgeon's skills, the surgical approach, the type of implant fixation, the intraoperative positioning of the patient, as well as pre-existing scars, the patient's sex, age and comorbidities. Diagnostic and therapeutic approaches should be based on the aetiology of the lesion: iatrogenic nerve lesions can result from direct (compression or transection) and/or indirect (traction, ischemia) trauma. The majority of nerve injuries encountered in hip or knee arthroplasty has been referred to as "minor" nerve lesions, which generally respond very well to non-operative treatment. "Major" nerve lesions, such as complete motor nerve transection, may result in lifelong impairment. Any perioperatively encountered neurological deficit requires a meticulous diagnostic work-up and an individually tailored treatment strategy, respecting aetiology and anatomic site of the nerve lesion as well as the individual patient's needs and comorbidities.

The Effect of an Educational Plan Based on the Roy Adaptation Model for Fatigue and Activities of Daily Living of Patients with Heart Failure Disease.

Cardiac failure is one of the most common chronic diseases with high rate of morbidity and mortality. Fatigue and decreased ability to perform daily activities are of the most common complications of this disease. The purpose of this study was to determine the effect of an educational plan based on Roy adaptation model on fatigue and daily activities in patients with heart failure. This experimental study was performed on 60 heart failure patients admitted in two educational hospitals supervised by the Kerman University of Medical Sciences in 2019. Sample was randomly assigned into two intervention and control groups. The intervention group received the care plan through a face-to-face and group training program in 6 sessions at one month. Interval followed by a follow-up period for 4 weeks later. Fatigue level was calculated based on piper fatigue scale, and daily activities were calculated by Barthes scale. The finding indicated that there was a significant difference between the two groups (control and intervention) after the intervention. The result showed that the intervention group had significantly lower mean scores in fatigue and higher mean scores in daily activities compared to the control group after intervention P ≤ .05. There was a significant relationship between fatigue and daily activities of life with frequency of hospitalization and duration of disease in both groups, P ≤ .05. Implementation of Roy model-based education program as a low-cost, effective, and non-aggressive nursing intervention can reduce fatigue, and improve daily activities in patients with heart failure.

Usability and acceptance of using a lower-limb exoskeleton controlled by a BMI in incomplete spinal cord injury patients: a case study.

Spinal cord injury (SCI) limits life expectancy and causes a restriction of patient's daily activities. In the last years, robotics exoskeletons have appeared as a promising rehabilitation and assistance tool for patients with motor limitations, as people that have suffered a SCI. The usability and clinical relevance of these robotics systems could be further enhanced by brain-machine interfaces (BMIs), as they can be used to foster patients' neuroplasticity. However, there are not many studies showing the use of BMIs to control exoskeletons with patients. In this work we show a case study where one SCI patient has used a BMI based on motor imagery (MI) in order to control a lower limb exoskeleton that assists their gait.

Hemifacial Microsomia Review: Recent Advancements in Understanding the Disease.

Hemifacial microsomia (HFM) is the second most common congenital disability of the face, with a prevalence of 1 in 3000 to 5600 live births. Although etiology is still not fully understood, including both genetics and environmental factors, the latest reports indicate the prominence of premature loss of the neural crest cells. What is more, a deficit of muscles of mastication, except the masseter, correlates in the pathomechanism of mandibular underdevelopment. Due to the significant phenotypic diversification, the typical picture of HFM cannot be determined. It may present as an esthetic concern-minor asymmetry with deformed auricle, and on the contrary, as microtia/anotia with conductive type hearing loss, hypoplastic mandible, and microphthalmia, impairing patient's daily activities. Referring to psychosocial problems, it has been proved that in population with HFM, there is a modestly elevated risk for behavior problems, social competence, and less acceptance. Over the years, more comprehensive methods of assessing the extent and severity of the HFM as the OMENS (+) classification have emerged. The authors like to summarize and present for plastic surgery resident and plastic surgeons the critical features of HFM, including the epidemiology, clinical presentation, pathogenesis, and innovative management reported in the current literature.

The negative impact of the COVID-19 lockdown on pain and physical function in patients with end-stage hip or knee osteoarthritis.

PurposeThe purpose of this study was to evaluate pain, functional impairment, mental health, and daily activity in patients with end-stage hip and knee osteoarthritis (OA) during the COVID-19 lockdown.MethodsThe study included 63 patients, with hip or knee OA, who had been scheduled for arthroplasty that was postponed because of COVID-19. Patients were evaluated by telephone interviews during the first week after lockdown, in the fourth week, and again at the end of the lockdown. Patients rated their pain level on the basis of a visual analog scale (VAS) and completed WOMAC, SF-12 and Tegner activity scale (TAS) questionnaires.ResultsVAS and WOMAC scores increased significantly during lockdown, while physical activity significantly decreased. At the final evaluation, VAS and WOMAC showed a significant negative correlation with TAS. The SF-12 subscale scores showed a significant decrease of the physical component during the lockdown, while the mental component remained largely unchanged. Patients with knee OA showed a faster progress of pain compared to those with hip OA. 50 patients (79%) stated they wished to have arthroplasty as soon as possible.ConclusionThe COVID-19 lockdown had a significant impact on pain, joint function, physical function, and physical activity in patients with end-stage hip and knee OA.Level of evidenceII (Prospective cohort study).Electronic supplementary materialThe online version of this article (10.1007/s00167-020-06104-3) contains supplementary material, which is available to authorized users.

Preliminary study of time estimation of daily activities in patients with chronic schizophrenia by questionnaire survey

Introduction Few studies have investigated time estimation of daily activities in patients with mental illness. Therefore, we conducted a preliminary study to extract the characteristics of time estimation in patients with schizophrenia. Method We conducted an investigation using the Questionnaire of Time Experience in Daily Activities in patients with schizophrenia and healthy controls. We compared the results between schizophrenia patients and healthy controls using t-tests. Results Thirty-four people participated in each group. T-tests showed significantly shorter length of time answers in the schizophrenia group for question 4, (“How long does it take you to go out after waking up in the morning?”). For question 5 (“When you have to take a bus, how long before departure time do you arrive at the bus stop?”) and question 6 (“You have an appointment with your friend. How long beforehand do you arrive at the appointed place?”), the answers of the schizophrenia group were significantly longer than the healthy controls. Conclusion Time estimations of some daily activities of patients with schizophrenia were significantly different from those of healthy controls. This study will support the next phase of psychometric testing of the Questionnaire of Time Experience in Daily Activities, after which the results will applicable to practice.

DaroACT: Darolutamide and enzalutamide effects on physical and neurocognitive function and daily activity in patients with castration-resistant prostate cancer (CRPC).

TPS5587 Background: The androgen receptor inhibitors (ARIs) apalutamide and enzalutamide (Enza) are approved for the treatment of men with advanced prostate cancer. These ARIs are associated with adverse events (AEs) including fatigue, neurocognitive dysfunction, and falls. Darolutamide (Daro) is a structurally distinct ARI approved by the FDA to treat nonmetastatic CRPC, based on significantly improved metastasis-free survival vs placebo in the ARAMIS Phase III clinical trial. Daro was not associated with a significant increase in AEs beyond that of concomitant androgen deprivation therapy, compared with placebo. DaroAcT is the first prospective trial to compare the effects of Daro to those of Enza on physical and neurocognitive function, and daily physical activity, in men with CRPC. Methods: This randomized, open-label, multicenter, Phase IIb trial (NCT04157088), involving ~20 sites across the US, is open for enrollment. After a lead-in phase of 30 pts treated with Daro alone, approximately 120 pts will be randomized 1:1 to receive Daro (600 mg twice daily) or Enza (160 mg once daily). Eligibility criteria include CRPC (metastatic and non-metastatic); age ≥18 years; Karnofsky performance status ≥80; no prior abiraterone within 6 months of enrollment, and no prior immunotherapy or apalutamide. All patients will continue luteinizing hormone-releasing hormone agonist or antagonist treatment for the duration of the study. The primary endpoint is the proportion of pts with slowed Timed Up and Go (TUG) time during the 24-week period from baseline. Secondary endpoints include the proportion of pts with worsening in short Physical Performance Battery (sPPB), mean change from baseline in daily physical activity, the proportion of pts with a decline in neurocognitive function or worsening of fatigue, and AEs. This study uses objective measures to assess physical function, including TUG and sPPB, measurements of daily activity levels with an accelerometry device for ≥7 days at designated time points, and neurocognitive tests. Fatigue is measured using the Brief Fatigue Inventory. Primary completion is estimated to be December 31, 2022. Clinical trial information: NCT04157088 .

The Reliability and Validity of the "Activity and Participation" Component in the Brief ICF Core Set for Chronic Obstructive Pulmonary Diseases Based on Rasch Analysis.

PurposeTo analyze the reliability and validity of the “activity and participation” component of the brief international classification of functioning, disability and health (ICF) core set for chronic obstructive pulmonary disease (COPD) using a Multi-faceted Rasch model.Patients and MethodsA total of 103 patients with COPD were selected by two raters to evaluate their ability levels in the four categories of the “activity and participation” component of brief ICF core set for COPD. The Multi-faceted Rasch model was used for data analysis. The analysis software used FACETS (Minifac) 3.67.0.ResultsThe “activity and participation” of brief ICF core set for COPD had a high internal consistency (separation index of 5.08, reliability of 0.96, P <0.05) and good inter-rater reliability (mean-square fit statistic range was 0.97–1.04, the separation index was 0.00, the reliability was 0.00, P >0.05), the construct validity was good (mean-square fit statistic range was 0.79–1.36), and the consistency of each category measurement was high (the separation index was 1.70, the reliability was 0.74).ConclusionThe “activity and participation” of brief ICF core set for COPD has good reliability and validity, which can be used to test the daily activities of patients with COPD.

The Use of Exergames in the Neurorehabilitation of People with Parkinson Disease: The Impact on Daily Life.

Introduction Parkinson disease (PD) is a progressive degeneration characterized by motor disorders, such as tremor, bradykinesia, stiffness and postural instability. Objective To evaluate the independence, confidence and balance in the development of daily activities in patients with PD before and after rehabilitation. Methods A descriptive, retrospective cross-sectional study was carried out with 16 patients (mean 57.6 ± 18.7 years), submitted to anamnesis, otolaryngological evaluation and vestibular assessment. The Vestibular Disorders Activities of Daily Living (VADL) and the Activities-Specific Balance Confidence (ABC) scales were applied before and after rehabilitation with virtual reality. Results a) The instrumental subscale of the questionnaire showed statistically significant result ( p = 0.022; 95% CI 1.21; 2.21) between the first and second assessments; b) The correlation between the questionnaires showed statistically significant result in the ambulation subscale ( p = 0.011; 95% CI −0.85; −0.17) first and ( p = 0.002, 95% CI −0.88; −0.31) second assessments, and the functional subscale was only verified in the second assessment ( p = 0.011, 95% CI −0.85; −0.17); and c) The patients presented clinical improvement in the final assessment after rehabilitation with significant result for the tightrope walk ( p = 0.034, 95% CI −12.5; −0.3) and ski slalom games ( p = 0.005, 95% CI −34.8; −6.6). Conclusions Our results showed that the VADL and ABC questionnaires, applied before and after rehabilitation, were important tools to measure the independence, confidence and balance while developing daily activities. The VADL and ABC questionnaires may effectively contribute to quantify the effect of the applied therapeutics and, consequently, its impact on the quality of life of patients with PD.

TRANSDERMAL FENTANYL PATCH FOR ACUTE PAIN CONTROL AFTER SHORT INTRAHOSPITAL STAY

Transdermal fentanyl patch (TFP) is used for alleviation of chronic pain, while scientific evidence regarding its use for acute pain is insufficient. Purpose. To compare the effects of pain control by non-steroidal anti-inflammatory drug (NSAID) and TFP and the restrictions in daily activities in patients following elective minor surgical interventions. Patients and methods. Prospective, randomised, casecontrolled study included patients aged ≥18 years who underwent elective cholecystectomy, gastric fundoplication or inguinal hernia repair. All randomised patients (fentanyl prescription group, FG, and control group, CG, 62 cases each) were administered dressing plasters for the first three post-operative days; the FG patients received 50mcg/h TFP under the plaster. Within the 4 post-operative days, the patients of both groups received diclofenac on demand. Post-operative pain at rest and during movement was evaluated using the Visual Analogue Scale on the 1st, 2nd, 3rd, 4th post-operative days. Daily activities using the Functional Activity Score were scored as 0 – no limitations, 1 – some limitations, 2 – severe limitations. Results. Pain both at rest and during movement on the first three post-operative days was lower in the FG; CG patients received 5 times more doses of diclofenac on demand on the 1st day after the surgery, with the higher need of NSAID during the next two days (p&lt;0.05). The total number of NSAID doses per patient administered on demand was 3.11±0.59 in the CG and 0.73±0.16 in the FG (p&lt;0.05). The influence of pain on daily activities on the 2nd post-operative day was scored as 0 by 92% patients and as 1 by 8% patients of the FG, versus 60% and 40% patients of the CG (p&lt;0.05). Conclusion. Patients with TFP experienced significantly more effective pain control leading to less restricted daily activities and used less doses of NSAID within the first few post-operative days. Plain Language Summary. Could a single long-lasting dose of transdermal fentanyl patch serve as an alternative to uncontrolled consumption of non-steroid anti-inflammatory drugs when dealing with early post-operative pain in patients following a hospital discharge after an elective minor surgery? Our conclusion suggests that the answer is “yes”, if the riskbenefits balance is evaluated.

The role of architectural design for rheumatic patients' wellbeing: the point of view of Environmental Psychology.

Rheumatic diseases (RD) are among the most frequent disorders in the population and the major causes of chronic pain and disability. The resulting consequences are catastrophic, leading to a significant socio-economic burden, which includes significant reductions in quality of life (QoL) and limitations in regular work and daily activities of patients. In spite of this, rheumatic diseases are often misunderstood or diagnosed late, probably due to their characteristics of silent diseases, sometimes unrecognizable to unaffected or unskilled people. Actually, it is surprising that, despite their consequences on QoL and on individual impact, rheumatic diseases are underestimated by the public opinion, which is probably more attracted by other major diseases causing death. This silent perception can even be seen in some among the most recent psycho-social approaches to population needs in the fields of Health Psychology and Environmental Psychology. The latter, also known as Architectural Psychology, is a branch of Psychology that analyses the effects of the built environment on humans, including those affected by diseases. Paradoxically, in many cases, some components of the environments created to protect individuals and/or the population may represent barriers and subsequently causes of disability and suffering in patients with rheumatic diseases. In order to increase awareness about this particular aspect of social life, HEMOVE Onlus, a non-profit association, has promoted the creation of a multidisciplinary Task Group, which included mainly rheumatologists, psychologists and architects, with the aim of applying also for the benefit of rheumatic patients the most modern technical skills available in the context of Environmental Psychology, including in particular design and information technology.