Reintegration Of Patients Research Articles

Heterogeneity of social participation in patients three months after total knee arthroplasty: a latent profile analysis

BackgroundSocial participation is an important index of rehabilitation and social reintegration in patients after total knee arthroplasty (TKA). However, most existing studies focus on improving patients’ functioning and activities, with only a few examining the social participation among patients after TKA. Therefore, the study aims to investigate the heterogeneity of social participation in patients three months after TKA and analyze subgroup influencing factors, to promote functional exercise and postoperative follow-up in specific patients.MethodsThis cross-sectional study recruited 255 patients who underwent TKA in a Tertiary Hospital in Jinan City, China, from March to July 2022. Three months after having undergone TKA, participants’ data were collected using the Numeric Pain Rating Scale, the Chinese version of the Tampa Scale of Kinesiophobia, the 10-item Kessler Psychological Distress Scale, Hospital for Special Surgery Knee-rating Scale, and Impact on Participation and Autonomy Questionnaire. Latent profile analysis was used to identify categories of patients’ social participation. Multiple logistic regression analysis was used to analyze the influencing factors of the different subgroups.ResultsThree months after TKA, the patients were divided into three subgroups: low social participation group (17.9%), moderate social participation group (40.8%), and high social participation group (41.3%). The vast majority of patients who underwent TKA exhibited moderate-to-high level of social participation. The multiple logistic regression analysis results showed that age, degree of pain, knee function, and kinesiophobia were the influencing factors of the potential profiles of social participation in patients three months after TKA (p < 0.05).ConclusionThese results support a distinct categorical feature of social participation among patients three months after undergoing TKA. Medical staff need to provide targeted guidance according to the potential classification characteristics of social participation to improve the level of social participation and promote rehabilitation of patients.

Custom-made ocular prosthesis: enhancing the iris position of post-evisceration patient

Individuals who have impaired vision as a result of illness or injury may have their appearance improved with the use of a prosthesis eye. To construct realism, symmetry, and a glance that appears natural, it is necessary to duplicate the size and arrangement of the iris with accurate pinpoint accuracy. This is crucial for developing a realistic-looking gaze. Eye loss has a profoundly debilitating impact on the mental state of the person who has suffered it. The ultimate goal of every ocular prosthesis procedure is to facilitate the patient's reintegration into society while preserving their healthy visage and self-esteem. This article provides a clinical report on the rehabilitation of a patient whose left eye had suffered intraocular foreign body damage following evisceration. A closer fit between the prosthesis and the ocular base tissue can be achieved with custom-made acrylic resin ocular prosthesis that are sized and shaped to fit the ocular socket of the patient. This close fit results in a more uniform distribution of pressure compared to factory stock eye prosthesis and is more cost-effective than stock eye prosthesis

Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study.

This study aims to determine the vision and mission of an academic hospital's medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital's geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU's functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU's vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient's network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.

L’entourage et la prise en charge psychiatrique ambulatoire en milieu pénitentiaire : enquête menée auprès des structures d’accompagnement vers la sortie implantées en France

ObjectivesA specific population category, that of prisoners, is particularly affected by mental health problems, as demonstrated by the main epidemiological studies on the subject. This finding has prompted the French prison administration to consider factors likely to improve the mental state of prisoners and reduce the chances of recidivism in the future. Among these factors, maintaining ties with family and friends is at the top of the list and is currently a priority for the prison administration. We wanted to understand how well professionals working in outpatient psychiatry in prisons were aware of this issue, particularly those who prepare patients for their release from prison. The principle aim of this study is to examine the current role of family and friends in the patient's care and within the systems that support patients on their release from prison. MethodsThis study is a prospective, multi-center qualitative study of medical staff working in discharge support structures, known as “SAS” in France, using semi-structured interviews. The SAS facilities included were those that existed and had been operating for at least one year at the time of the interviews. The interviews were conducted until all the data were compiled. ResultsSixteen interviews were carried out. The results show that in the majority of cases there was no contact with the patient's family and friends during the outpatient psychiatric care in prisons. This contrasts with the repeated reference to family and friends in the comments made by caregivers during the interviews. For the vast majority, the people close to the patient are considered to be the pillars of the patient's reintegration into society, and caregivers would like to integrate the patients’ entourages more significantly into their practices. According to several of the people interviewed, those close to the patient have an influence on the development and recurrence of mental disorders, on the experience of imprisonment and on acting out. Caregivers perceive many benefits from the inclusion of family and friends, both for the patient and his or her loved ones. On the other hand, the study showed that there are limits to this integration in treatment, specifically those concerning the prison institution, the caregivers and the patients themselves. This study provides several elements confirming the idea that the SAS is a structure conducive to the inclusion of family and friends in psychiatric practices. Finally, the results highlight some innovative ideas for integrating family and friends into this pre-release care. ConclusionsCurrently, there is little integration of family and friends in the outpatient psychiatric care of patients in French prisons, particularly within the SAS. This study proposes future developments in these practices and suggests some very interesting perspectives on the subject. Integrating family and friends into care can be achieved by taking the concrete steps set out in this study, in order to provide optimum care and overall patient management.

The complex impact of family caregiver kinship type on the rehabilitation of patients with mental disorders in rural communities of China.

In 2009, the Chinese government incorporated severe mental disorders into the central subsidized local health funding project for the effective management, treatment, and reintegration of patients with severe mental disorders from hospitals into the community (Project 686). The conditions that were classified as 'severe' by this project included: schizophrenia, schizoaffective disorders, paranoid disorders, bipolar disorders, mental disorders caused by epilepsy, and mental retardation accompanying mental disorders. Patients in rural communities received better care after project implementation, of which 62.91% were farmers. This paper attempts to investigate the complex impact of Project 686 on the levels of rehabilitation of patients by their families. The last follow-up visit of the community psychiatrists in city H in 2020 was used as the time point. Finally, 174 samples were used in the analysis model. The type of kinship between family caregivers and patients with mental disorders was operationalized according to the information provided under the 'primary caregiver' item within the basic information section of the follow-up form. The software Stata15 was used to perform descriptive statistics, baseline regression model analysis, and a robustness test on the types of kinship identified and patients' recovery. The types of kinship, current symptoms, and medication use all affected patients' recovery, were found to have regression coefficients of -0.148, -1.756, and 0.902, respectively. Parents of patients with mental disorders remain in the caregiver category with the largest proportion. Community acceptance of patients is high; current symptoms, medication use, and types of caregiver-patient relationships influence patients' recovery levels. Project 686 has solved some of the rehabilitation and living difficulties of patients with mental disorders in rural communities. The types of kinship between family caregivers and patients with mental disorders in rural communities affect patients' rehabilitation levels. Patients' current symptoms and medication use can effectively moderate the impact of kinship type on patients' recovery in terms of complete self-knowledge, productive work, and life and good social relationships. It is necessary for mental illness prevention-treatment organizations to establish supplemental, replacement, and substitution mechanisms for the life and rehabilitation of patients with mental disorders in rural communities. Furthermore, the sense of reward and concern for family caregivers should be actively enhanced, and greater scientific use of the rehabilitation function of the 'family care + village doctor management' model should be made.

Blenderized formulations in home enteral nutrition: a narrative review about challenges in nutritional security and food safety.

Blenderized formulations (BFs) are prepared by homogenization of food that is normally used in oral nutrition. BFs are mainly used in home enteral nutrition (HEN), although their use has also been reported by hospitals when commercial enteral formulas are not available. HEN is applied when the patient has been discharged from the hospital. This nutritional therapy promotes the patient's reintegration into the family nucleus and promotes humanized care, and decreases treatment costs. However, the patient should continue to receive health and nutritional care, ranging from periodic nutritional re-evaluation to adaptation of the dietary plan. HEN provides the patient a greater contact with the family, whereas BFs promote the adaptation of the diet with food, respecting the food diversity and culture, lower cost, and easier access to food. Disadvantages of BFs include more time spent by the professional to calculate the dietary plan, greater difficulty in adjusting daily needs, and less microbiological and chemical stability. In this review, the nutritional, food security, and safety aspects of BF used in HEN are discussed. Technological quality aspects that are essential knowledge in the preparation of the patient's dietary plan also are presented.

Barriers to Community Re-integration of patients with Spinal Cord Injuries

Barriers to Community Re-integration of patients with Spinal Cord Injuries

The Relationship Between Quality of Life and Perception Over Social Reintegration in Patients Suffering from Aphasia: the Mediating Role of Social Support and Moderator Role of Gender and Family Support

Background. The quality of life in patients suffering from aphasia, survivors of a stroke, is considerably lower compared to patients who have suffered from other types of stroke. In order to observe the changes that occur at a psychological level in patients suffering from aphasia, it is necessary to investigate the relationship between quality of life and their social reintegration. Objectives. This cross-sectional research aims to identify those elements of quality of life that can enhance a healthy and stable social reintegration over time in patients suffering from aphasia. Materials and methods. The research was performed on a sample of 103 patients suffering from aphasia. Participants answered four questionnaires: Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39), The Community Integration Questionnaire Revisited (CIQ), Perceived Social Support Questionnaire (F-SozU) and Perceived Social Support - Family Form (PSS- Fa). The data were processed via SPSS V28 and Process V3.5. Results. The quality of life is a statistically significant predictor for the social reintegration of patients suffering from aphasia. Gender and family support were not found to be significant moderators of the relationship between quality of life and social reintegration. Social support was found to be a statistically insignificant mediator in the relationship between quality of life and social reintegration of patients suffering from aphasia.

Hygienic substantiation of measures to optimize living conditions and rehabilitation in new types of institutions for patients with mental disorders

Annotation. In contrast to Ukraine, psychosocial rehabilitation in European countries today is gaining considerable popularity for the socialization and reintegration of patients with mental disorders, for their more adaptive self-improvement. The article analyzes the experience in the EU in the latest, modern, psychosocial methods of providing medical care/rehabilitation to patients with mental disorders to improve patient self-management skills, personal reintegration, development of adaptive properties, self-improvement and to reduce health care costs. Hygienic substantiation of measures to optimize living conditions and treatment and rehabilitation process for patients with mental and behavioral disorders. To perform the tasks in the sociological study involved 92 people – relatives of patients with mental disorders using a specially designed questionnaire: “A method of determining the quality of medical care by relatives of a psychiatric patient and the relationship “doctor-relative””. The survey had conducted in January 2020 before the start of quarantine on COVID-19 and the beginning of the second phase of medical reform in the field of psychiatry. The work used content analysis of domestic and foreign scientific sources, bibliosemantic, analytical, and statistical research methods. It has found that the most significant problems faced by patients in providing them with psychiatric care, according to relatives, are the inconsistency of sanitary and hygienic conditions of patients in psychiatric hospitals – 62.6%, low quality of care – 37.3% and inattentive attitude on the part of medical staff – 34.7%. A sociological survey of relatives of patients with mental and behavioral disorders found that patients are referring for treatment only in critical conditions. Treatment of patients with mental and behavioral disorders nowadays, it is necessary to introduce a comprehensive approach, not just psychopharmacological drugs. To do this, each patient must individually develop psychosocial rehabilitation methods: training in music therapy, communication, motivation, sports training, bibliotherapy, art therapy, animal therapy, training to improve social adaptation, activation of independence, as is done in the EU.

Economic analysis of hospital/healthcare costs in patients with colorectal digestive anastomosis

"Abstract: Intestinal anastomoses have always been a major problem in digestive surgery. With the use of mechanical suture devices, intestinal anastomosis techniques have improved, allowing standardization of methods and shorter duration of surgical procedures. In addition to shortening the operative time, reduced operating room utilization and length of stay (LOS), health financial strain is also reduced by a lower rate of postoperative complications, quicker recovery and socioprofessional reintegration of patients, and by lowering costs related to treating permanent disabilities such as permanent intestinal stoma. The aim of this study was to estimate the costs of surgical patients with colorectal anastomosis (mechanical or manual suturing) and to identify economically efficient surgical techniques. Material and method: Unicentric 10-year retrospective study in the Bucharest ""Prof. Dr. D. Gerota"" Emergency Hospital. The costs associated with manually constructed and stapled anastomoses in colorectal surgery were compared. Results: In the group with manual colorectal anastomoses (363 patients) the costs per patient were on average 5190 RON and the average hospital stay 14.95 days. In the group with mechanical colorectal anastomoses (97 patients) the average cost per patient was 5037 RON with an average hospital stay of 11.5 days. Conclusions: The use of mechanical colorectal suture devices resulted in a cost reduction of approximately 150 RON per case and a shortening of average hospital stay by 3.45 days. In addition to these direct benefits, we also list the increase in surgical volume (including the diversification of the range of operations) or indirect effects such as faster socioprofessional reintegration of patients. Keywords: intestinal anastomosis, mechanical sutures, costs "

The importance of social reintegration in patients with major depressive disorder

Major depressive disorder is a leading cause of disability worldwide, associated with poor health, impairment, substance use disorders, mortality, disease and economic burden. We studied the case of a patient with a history of alcohol consumption and affective disorder admitted for many times in the Psychiatry Clinic I of the Clinical Hospital of Neuropsihiatry of Craiova. We had a multidisciplinary approach, based on communication and empathy, using all means for the patient’s well-being: drug treatment, psychotherapy, social reintegration. This kind of approach is always the key to success, fighting on many fronts but for a common goal: relieving the patient’s suffering.

Интеграция ресурсов системного подхода М. Спивака, когнитивно-бихевиоральной терапии и культурно-исторической психологии в решении задач реформирования психоневрологических интернатов в России

2016, the Russian Federation started a reform of residential institutions for psy¬chiatric patients. An essential condition of its success is reintegration of patients into society, which implies development and implementation of effective psychosocial rehabilitation programs. Materials and Methods. In 2018, an integrated rehabilita¬tion program was developed and implemented for the first time in Psychoneurologi¬cal Residential Institution No. 22 in Moscow. The program integrated the principles and methods of M. Spivak’s systemic approach, cultural-historical psychology, and cognitive-behavioral therapy. The rehabilitation group included 12 patients with chronic mental disorders and disabilities who had resided in the institution for 3 to 16 years. The total duration of the program was 6 months. An expert assessment of the participants’ psychological and social competencies in the major life areas (housing and everyday life; work and employment; hygiene; interpersonal relations; hobbies and leisure) was carried out before and after the rehabilitation program, using Spivak’s diagnostic scales. Results. A study of the integrated rehabilitation program effectiveness showed a statistically significant improvement in the patients’ competencies in the major life areas. Follow-up of the dynamics within the follow¬ing 3 years upon the program completion revealed positive changes in their social adaptation. Output. A preliminary conclusion could be made that the proposed in¬tegrated rehabilitation program might be effective for shaping and training of social skills that increase the patients’ autonomy, as well as for overcoming self-limiting attitudes and avoidance strategies resulting from their negative experience of social “defeats” and institutional experience of learned helplessness. Each of the three in-tegrated approaches contributed to achieving the rehabilitation objectives. Further research with larger samples is needed.

Post stroke depression and its effects on functional rehabilitation of patients: socio-cultural disability communities

Background: Stroke is considered to be the third, most frequent cause of death and the leading cause of disability in Western societies. Apart from physical problems, stroke can cause psychological and social problems, too as post Stroke Depression (PSD) which is the most common emotional disorder that usually occurs in the first months, in about 1/3 of patients surviving after stroke.Aim: To describe the frequency of post stroke depression (PSD) and its effects on functional recovery of patients.Method: A systematic review was conducted on databases MEDLINE, PUBMED, CINAHL, and the web using Google Scholar.Results: Thirty articles were retrieved, from 2000 and onwards which met the selection criteria. According to the results, PSD is a common and serious complication after stroke. Approximately 1/3 of the patients have a type of depression in the first year after stroke, with the risk increasing, the first months of the onset of stroke. The researchers suggest that there is a collaborative relationship between stroke and depression, which leads to inability to perform activities of daily living and slows the rehabilitation of patients.Conclusion: Early detection of PSD and the implementation of appropriate therapeutic interventions in rehabilitation units help to speed up the recovery process and reintegration of patients into society.

Identifying and addressing gaps in the implementation of a community care team for care of Patients with multiple chronic conditions

BackgroundPatients with multiple chronic conditions represent a growing segment for healthcare. The Chronic Care Model (CCM) supports leveraging community programs to support patients and their caregivers overwhelmed by their treatment plans, but this component has lagged behind the adoption of other model elements. Community Care Teams (CCTs) leverage partnerships between healthcare delivery systems and existing community programs to address this deficiency. There remains a gap in moving CCTs from pilot phase to sustainable full-scale programs. Therefore, the purpose of this study was to identify the cognitive and structural needs of clinicians, social workers, and nurse care coordinators to effectively refer appropriate patients to the CCT and the value these stakeholders derived from referring to and receiving feedback from the CCT. We then sought to translate this knowledge into an implementation toolkit to bridge implementation gaps.MethodsOur research process was guided by the Assess, Innovate, Develop, Engage, and Devolve (AIDED) implementation science framework. During the Assess process we conducted chart reviews, interviews, and observations and in Innovate and Develop phases, we worked with stakeholders to develop an implementation toolkit. The Engage and Devolve phases disseminate the toolkit through social networks of clinical champions and are ongoing.ResultsWe completed 14 chart reviews, 11 interviews, and 2 observations. From these, facilitators and barriers to CCT referrals and patient re-integration into primary care were identified. These insights informed the development of a toolkit with seven components to address implementation gaps identified by the researchers and stakeholders.ConclusionWe identified implementation gaps to sustaining the CCT program, a community-healthcare partnership, and used this information to build an implementation toolkit. We established liaisons with clinical champions to diffuse this information. The AIDED Model, not previously used in high-income countries’ primary care settings, proved adaptable and useful.

Discrepancies between Self- and Clinical Staff Members' Perception of Cognitive Functioning among Patients with Schizophrenia Undergoing Long-Term Hospitalization.

In Japan, long-term hospitalization of patients with schizophrenia is still prevalent, even though the focus of psychiatric care is shifting from hospitals to the community. Difficulties in discharge planning often arise because clinical staff members' functional assessment differs from that of patients' self-assessment. Therefore, we attempted to identify characteristics related to these perceptual differences to promote the development of more effective approaches toward the discharge and societal reintegration of patients with schizophrenia undergoing prolonged hospitalization. Forty-eight long-term inpatients (23 men and 25 women with a mean age of 60.72 years) with schizophrenia were examined using the Schizophrenia Cognition Rating Scale Japanese version (SCoRS-J), Life Skills Profile (LSP), and Profile of Mood States- (POMS-) Brief Form. Differences between patients' self-ratings and clinical staff members' ratings on the SCoRS-J were used to divide patients into overestimators, underestimators, and accurate raters. These groups were then comparatively analyzed. Accordingly, overestimators displayed significantly severe cognitive dysfunction on the SCoRS-J objective ratings (p = .001) and significantly less difficulty on the SCoRS-J subjective ratings (p = .002) as compared to underestimators. Overestimators also scored significantly lower on the communication (p = .012) and responsibility (p = .021) LSP subscales compared to underestimators, and the total LSP score for overestimators was significantly lower compared to accurate raters (p = .036) and underestimators (p = .009). However, underestimators displayed significantly higher confusion on the titular POMS subscale than did overestimators (p = .021). These findings indicate that, among the three groups, overestimators scored lowest for objectively rated functioning. In contrast, underestimators attained the highest functioning; however, they were also confused. Clinical staff should examine how patients' self-perceptions deviate from the perceptions of staff and implement an appropriate approach considering the patient characteristics revealed from the results of this study.

Perspectives on hospital and community-liked education program for community reintegration in patients with stroke and traumatic brain injury

Most of patients with stroke and traumatic brain injury (TBI) suffer from lack of persistent and appropriate rehabilitation program after discharge. It is needed to develop the hospital and community-linked education program (HCLEP) for community reintegration of patients with brain injury after discharge. Thus, the aim of this study was to investigate perspectives of health professionals in rehabilitation field to decide appropriate items in HCLEP. In this study, rehabilitation physician, nurse, physical therapist, occupational therapist, social worker, and others were participated ( n = 204). An electronic survey was performed to decide education items for community reintegration of patients with stroke and TBI. To quantify the required degree of several items, which can be included, Likert 5 point scale was used and a rating average for responses of each item was calculated. In this study, respondents strongly agreed safety management, functional maintenance and improvement, emergency management, and prevention of secondary disorders as appropriate items of education for community reintegration in patients with stroke and TBI. Personal counseling ( n = 97) and small group learning with 3-5 individuals ( n = 80) were selected as suitable teaching methods. Participants responded that education content type using video is appropriate ( n = 94). Social worker was selected as an appropriate educator ( n = 147). The present results provides fundamental information which be needed to develop HCLEP for persistent rehabilitation in patients with stroke and TBI. Further studies are needed to reach a consensus of professionals or patients for specific items included in the education contents.

P.3.002 - Stigmatic attitudes towards mentally ill patients in Hungary between 2001 and 2015: results of a time-trend analysis

Background Stigmatic attitudes towards people with the diagnosis of mental illness are widespread in the general public [1] and are the major obstacle for successful treatment, rehabilitation and reintegration of patients into the society [2]. Given the magnitude of this issue, and in the effort to develop effective anti stigma intervention programs, trend analysis studies were conducted, examining the changes in attitudes over the years [3]. The construct of social distance, which involves the desire to avoid contact with a particular group of people was commonly used to assess stigma. These studies have consistently reported that despite the improvement in mental health literacy of the public, social distance preferences concerning mentally ill patients have not changed over the last 20 years, and in some cases have even increased [3]. However, the number of studies using trend analysis is scarce and mainly limited to wealthier countries because such studies are both costly and time intensive. Consequently, most studies to date have been carried out in North Western Europe whereas data from Central and Eastern European countries, especially from former communist countries, is lacking [4,5]. Objective In the face of underfinanced mental health system and the lack of any national anti-stigma programs or research, the aim of this study is to shed light into mental illness stigma in Hungary. More specifically, this study aimed to explore for the first time, potential changes concerning attitudes of the Hungarian population towards mentally ill patients. Method National representative surveys (N=7605) of adults aged 18-53 years were carried out in Hungary in 2001, 2003, 2007 and 2015. An interview was conducted, asking for socio-demographic information and participants' desire for social distance from mentally ill patients, measured by Bogardus social distance scale. In order to put into context the stigmatic attitudes towards mentally ill patients, participants were also asked to report on their social distance preferences towards other minorities in the Hungarian society. Trend analysis was performed to examine the trends of social distance. Results Time-trend analysis indicated a significant (positive) trend in public preferences for social distance towards more accepting attitudes during the years of 2001-2015. However, closer examination reveals that the effect size is very small (0.05) and the 2015 rejection level is still high (57%) compared to over 60% in both 2001 and 2003. Moreover, during a period of 15 years, mentally ill patients are among the three most rejected groups in the society (with only alcoholics and drug users being more rejected). Conclusions As was found in other countries around the world, in Hungary as well, stigmatic attitudes towards mentally ill patients are highly prevalent, and have not changed over the last decade. While stressing a worrisome reality in Hungary, where no efforts to tackle mental illness stigma were done, this study also verifies the enormity of the stigma phenomenon. It is evident, maybe more than anything, that much effort is needed in Hungary, but also worldwide, in order to understand and defeat mental illness stigma.

Evaluation of Predictive Factors Influencing Community Reintegration in Adult Patients with Stroke

Objectives:Patients with stroke are faced with gait, balance, and fall difficulties which could impact on their community reintegration. In Nigeria, community reintegration after stroke has been understudied. The objective of this study was to evaluate the predictors of community reintegration in adult patients with stroke.Materials and Methods:Participants were 91 adult patients with stroke. Gait variables, balance self-efficacy, community balance/mobility, and fall self-efficacy were assessed using Rivermead Mobility Index, Activities-specific Balance Confidence Scale, Community Balance and Mobility Scale, and Falls Efficacy Scale-International respectively. Reintegration to Normal Living Index was used to assess satisfaction with community reintegration. Pearson Product-Moment Correlation Coefficient was used to determine the relationship between community reintegration and gait spatiotemporal variables, balance performance, and risk of fall. Multiple regression analysis was used to determine predictors of community reintegration (P ≤ 0.05).Results:There was significant positive relationship between community reintegration and cadence (r = 0.250, P = 0.017), functional mobility (r = 0.503, P = 0.001), balance self-efficacy (r = 0.608, P = 0.001), community balance/mobility (r = 0.586, P = 0.001), and duration of stroke (r = 0.220, P = 0.036). Stride time (r = −0.282, P = 0.073) and fall self-efficacy (r = 0.566, P = 0.001) were negatively correlated with community reintegration. Duration of stroke, balance self-efficacy, community balance/mobility, and fall self-efficacy (52.7% of the variance) were the significant predictors of community reintegration.Conclusion:Community reintegration is influenced by cadence, functional mobility, balance self-efficacy, community balance/mobility, and duration of stroke. Hence, improving balance and mobility during rehabilitation is important in enhancing community reintegration in patients with stroke.

Risk Assessment for Complications of Partial Nephrectomy – Comparative Study between Retroperitoneoscopic Approach and Open Surgery

Introduction. Partial nephrectomy represent the standard of care for small renal tumor. Laproscopic approach tends to replace open surgery due to similar oncologic results, but with better eastethic outcomes and earlier socio-professional reintegration. Material and methods. Between January 2010 and February 2017, 55 patients (p) underwent partial nephrectomy at our center for clinically localized renal tumor, 21p with LPN by retroperitoneal approach and 34p with OPN. All patients had a normal contralateral kidney. The selection of patients for nephron-sparing surgery was based on preoperative CT scan, location of the tumor, the individual general health status of the patient and individual surgeon preferences. Results. The mean age of patients with partial nephrectomy was 59.6±16.4 years, with 57.9±11.6 years for laparoscopic subgroup and 61.3±12.4 for open surgery. The transfusion rate was 9.52% in LPN group, while in the OPN there was no need for transfusion. The warm ischemia time was higher in the LPN group (21.8±7.2 min) than OPN group (15.7±2.9). The postoperative complication rate is comparable between LPN and OPN (23.81% v.s. 20.58%), but the LPN had higher intraoperative complications. Conclusion. Laparoscopic partial nephrectomy for renal tumors is superior to open surgery by early mobilization of the patient, the low rate of wound complications, short duration of hospitalization, fast socio-professional reintegration of patient, despite the perioperative complication rate that is higher but of low ClavienDindo grade.

Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: findings after more than 20 years

OBJECTIVE The goal of this study was to examine long-term quality of life (QOL) and reintegration in patients with good neurological recovery after aneurysmal subarachnoid hemorrhage (aSAH) and SAH of unknown cause (SAH NUD). METHODS A long-term follow-up was performed in an original cohort of 113 individuals who had suffered SAH (93 with aSAH and 20 with SAH NUD) between 1977 and 1984. Self-reporting assessments, performed > 20 years after the bleeding episode, included the Quality of Life Scale (QOLS), Psychological General Well-Being (PGWB) index, and Reintegration to Normal Living (RNL) index, along with information on sleep disturbances and work status. RESULTS Seventy-one survivors were identified. Questionnaires were returned by 67 individuals who had suffered SAH 20-28 years previously. The QOL was rated in the normal range for both the QOLS score (aSAH 90.3 vs SAH NUD 88.6) and the PGWB index (aSAH 105.9 vs SAH NUD 102.8). Ninety percent of patients had returned to their previous employment. Complete RNL was reported by 40% of patients with aSAH and by 46% of patients with SAH NUD; mild to moderate readjustment difficulties by 55% and 38%, respectively; and severe difficulties by 5% of patients with aSAH and 15% of patients with SAH NUD. Self-rated aspects of cognition, mood, and energy resources in addition resulted in a substantial drop in overall reintegration. Sleep disturbances were reported by 26%. CONCLUSIONS More than half of patients with SAH who had early good neurological recovery experienced reintegration difficulties after > 20 years. However, the general QOL was not adversely affected by this impairment. Inability to return to work after SAH was associated with lower QOLS scores. Sleep disturbances were associated with lower PGWB scores.