Rehabilitation Hospital Research Articles

Диагностика уровня психических нарушений у комбатантов с острым стрессовым расстройством на этапе госпитальной реабилитации

<p>The purpose of the study was to evaluate methods for diagnosing the level of mental disorders in combatants with acute stress disorder. The study presents data from an experimental sample of male military combatants with acute stress disorder (N=39) undergoing medical rehabilitation in a military clinical hospital. To assess the level of mental disorders, we used the “Stanford Acute Stress Reaction Questionnaire” (SASRQ), the “Module-support” (Module-s) questionnaire, and the “Inventory of Neurotic Disorders-Symptomatic” (IND-S). The results showed that the SASRQ provided a reliable assessment of the level of mental disorders, whereas the Module-S and IND-S questionnaires had overlapping indicators across groups, making it difficult to interpret the results unambiguously. It was found that in a military clinical hospital, the largest group of combatants with acute stress disorder (49%) had a neurotic level of mental disorders, classified as temporary psychogenic losses, and required psychotherapeutic help. The second largest group of patients was 36% and had a prenosological level of mental disorders. These patients did not require further evacuation, they required psychological assistance with a subsequent return to duty. Military personnel in the psychogenic losses group (psychotic level) accounted for 15%, these individuals required evacuation to rear medical institutions for specialized psychiatric care.</p>

Appraising motivation as a predictor of independence in individual activities of daily living in patients with subacute stroke: a retrospective study

ABSTRACT Objectives This study aimed to evaluate the impact of motivation on independence in activities of daily living, such as eating, getting up, and rehabilitation, in subacute stroke patients. Materials and Methods We retrospectively assessed the data of 191 first-stroke patients in a rehabilitation hospital ward. Motivation was examined using the following five elements of the Vitality Index: waking pattern, communication, feeding, on and off toilet, and rehabilitation and other activities. As an outcome measure, independence in activities of daily living, such as eating and dressing, was assessed using the Barthel Index. Logistic regression analysis was performed using the independence of each activities of daily living, as determined by the Barthel Index at discharge, as a dependent variable and each of the Vitality Index item scores as the independent variable. Results Motivation to get up item of the Vitality Index was significantly associated with independence in grooming and dressing, whereas motivation to communicate item was significantly associated with independence in transferring (p < 0.05). Furthermore, motivation to eat item was significantly associated with independence in feeding, grooming, dressing, and transferring, whereas motivation to engage in rehabilitation and activities was significantly associated with independence in dressing, transferring, and toileting (p < 0.05). Conclusions Our results suggest that the motivation to eat, get up, communicate, and participate in rehabilitation and activities is associated with independence in different activities of daily living. The present study provides useful insights into the significance and interpretation of assessing motivation on independence in activities of daily living.

Rasch Analysis of the Chinese Version of the Nociception Coma Scale–Revised in Patients with Prolonged Disorders of Consciousness

Objectives The aim of this study was to analyze the Chinese version of the Nociception Coma Scale–Revised in patients with prolonged disorders of consciousness within the framework of Rasch modeling, including investigating the invariance of total scores across different etiologies of disorders of consciousness. Design Prospective psychometric study. Participants Patients with prolonged disorders of consciousness from the Rehabilitation and Neurology units in hospital. Interventions None. Main Outcome Measure The Nociception Coma Scale–Revised was undertaken by trained raters and the Coma Recovery Scale-Revised was used to assess patients’ consciousness. The psychometric properties within the Rasch model including item-person targeting, reliability and separation, item fit, unidimensionality, and differential item functioning were assessed. Results 84 patients with prolonged disorders of consciousness (mean age 53 years; mean injury 5 months; 42 with Minimally Conscious State and 42 with Unresponsive Wakefulness Syndrome) of 252 observations were enrolled in the study. Through the procedure of repeated assessment and differential item function, a lower item bias Rasch set was purified. The Rasch model assumptions were examined and met, with item reliability and validity meeting the recommended threshold. Conclusions The Chinese version of the Nociception Coma Scale–Revised demonstrated unidimensionality, good reliability and separation, and good item fit, but dissatisfied person fit and item-person targeting. The verbal subscale showed a notable discrepancy between person responses and the difficulty of the items, suggesting limited clinical significance.

Investigating combined acupuncture and transcranial direct current stimulation in patients with poststroke shoulder pain from China: protocol for a randomised controlled trial

IntroductionPoststroke shoulder pain is a common complication that severely affects the recovery of upper limb motor function. Acupuncture has positive analgesic effects in treating poststroke shoulder pain, and studies have...

Justice sensitivity among nurses and physiotherapists in a Croatian rehabilitation hospital.

The aim of this study was to investigate and compare justice sensitivity between self-perceived beneficiaries, victims, and observers in a sample of 90 healthcare workers (nurses and physiotherapists) at the Varaždinske Toplice Special Medical Rehabilitation Hospital, Croatia. For this purpose we used a questionnaire consisting of demographic data and the Croatian version of the justice sensitivity inventory developed by Schmitt. Regardless of its limitations, our study clearly shows that healthcare professionals at Varaždinske Toplice are most sensitive to injustice from the beneficiary's perspective, that is, as persons who personally benefitted from injustice, although they may not have been instrumental to this effect. They are less sensitive to injustice perceived on the outside (observer's perspective) or to injustice suffered by themselves (victim's perspective). Another important finding is that participants of female gender, rural residence, and nurses (who are all women) are significantly more sensitive to injustice, whereas age and marital status do not seem to contribute to justice sensitivity. Future research should investigate the perception of injustice over a longer timeframe and involve all healthcare workers. It could also address different approaches to management, especially in terms of worker rewards and career advancement. Qualitative research among healthcare workers could provide a broader and clearer idea of social injustice at their workplace.

Functional and Radiological Outcome of Simultaneous Bilateral Total Knee Replacement in a Tertiary Care Centre : A Quasi-prospective Study.

Osteoarthritis (OA) is the most frequent joint disease with a prevalence of 5313 per 100,000 persons in India. OA of the knee is a major contributor to mobility impairment, particularly among women. In these patients, total knee replacement (TKR) is widely accepted as the gold standard treatment for pain relief and restoration of function. Now, patients have the option of undergoing either a simultaneous bilateral TKR or a staged TKR. The former has shown significant advantages such as shorter rehabilitation, cost efficacy and shorter hospital stay. This study aimed to assess the functional and radiological outcome of simultaneous bilateral TKR in a tertiary care centre. 30 adult patients above the age of 55 years with severe OA knee who underwent simultaneous bilateral TKR between 2022-2023 were included in this prospective study. Preoperatively, they were assessed with radiographs including full length scannograms. Mean Anatomical Axis, Mean Mechanical Axis and Mechanical Axis Deviation (Varus) were calculated based on the scannograms by a single observer. The same observer administered the oxford knee score (OKS) preoperatively to all patients. Regular clinical and radiological follow up was done. After 1 year follow up, the same observer administered the Oxford Knee Score (OKS) to the operated knee. With a female preponderance among the study subjects (56.7%), the majority of the cases in our cohort were characterised as Grade IV Kellgren-Lawrence radiological grade of Osteoarthritis (76.66%) and were found to have tricompartmental involvement (70%). The mean anatomical axis for the right and left lower limb were 4.56±5.17 and 9.68±1.72 respectively. The mean mechanical axis deviation (Varus) for the right and left lower limb were 31.6±15.1 and 52.0±13.9 respectively. Preoperatively, mean mechanical axis for the right and left lower limb were 9.95±4.31 and 14.2 ±0.67 respectively. Postoperatively, mechanical axis was restored to near-normal values (3-5 degrees). Significant improvement in mean OKS from a preoperative value of 18.30 ± 3.46 to postoperative value of 33.50 ± 5.32 was noted at 1 year. Treatment of severe bilateral OA knee with simultaneous single staged bilateral TKR ensures good functional outcome , early mobility with minimal complications.

The effects of perceived therapist guidance and advice on adherence to home-based exercise programs in mothers of children with cerebral palsy in Rwanda

BackgroundThe alarming prevalence of non- or poor adherence to Home-based Exercise Programs (34–79.2 %, HEP) in parents of Children with Cerebral Palsy (C-CP) is a global health concern due to its detrimental effect on treatment outcomes. ObjectiveTo examine whether Perceived Therapist Guidance and Advice (TGA) or social support moderate the effects of PTSD, depression, parenting stress, low self-efficacy, the burden of care, or the effects of perceived family stigma on adherence to HEP. MethodA stratified random sample of 301 mothers of C-CP attending the largest seven physical rehabilitation hospitals or centres in Rwanda participated in this study. Data were collected using validated measures of all investigated constructs. We conducted hierarchical multiple linear regressions, and the nature of moderation was scrutinized using the process macro 4.1 model number 1 within SPSS version 28. ResultsThe prevalence of adherence to HEP in the present sample was 32.9 %. Mothers' TGA and social support were positively associated with adherence to HEP; whereas mothers' stressors, including PTSD, parenting stress, depression symptoms, low self-efficacy, burden of care, and family stigma were negatively associated with adherence to HEP. In addition, TGA significantly moderated the associations of the different mothers' stressors with adherence to HEP, leading to increased HEP adherence for mothers with high stressor levels. Social support did not moderate any of these associations. Our respondents often reported poor family and friends’ social support due to family stigma-related to caring C-CP. ConclusionsTherapists play a vital role by providing education, support, and counselling to parents, emphasizing the importance of adherence, and addressing any stigma-related concerns, especially for mothers who experience high levels of stress. Therapists should be aware that mothers of C-CP frequently relied solely on their support to improve adherence to HEP.

Establishment of a risk prediction model for cerebrogenic multiple organ dysfunction syndrome in patients with acute cerebral hemorrhage

To construct and validate a predictive model for the risk of cerebrogenic multiple organ dysfunction syndrome (CMODS) in patients with acute cerebral hemorrhage. Clinical data of 93 patients with acute cerebral hemorrhage admitted to Wannan Rehabilitation Hospital from January 2019 to June 2023 were retrospectively analyzed. Data included baseline information, disease severity score, laboratory examination indicators, cerebral hemorrhage status, treatment status, etc. Patients were divided into CMODS group and non-CMODS group according to whether CMODS occurred during hospitalization. The clinical data of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of CMODS in patients with acute cerebral hemorrhage. A nomogram model was constructed to predict the risk of CMODS in patients with acute cerebral hemorrhage, and the model was validated. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive efficiency of nomogram model for CMODS in patients with acute cerebral hemorrhage. A total of 93 patients with acute cerebral hemorrhage were enrolled, including 26 patients in CMODS group and 67 patients in non-CMODS group. Compared with the non-CMODS group, the ratio of diabetes, acute physiological and chronic health evaluation II (APACHE II)≥35 score, cerebral hemorrhage volume ≥30 mL, endotoxemia, and national institutes of health stroke scale (NIHSS) and intracranial pressure of patients in the CMODS group were significantly higher, while the Glasgow coma score (GCS) was significantly lower and the length of hospital stay was significantly longer, with statistically significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus [odds ratio (OR) = 3.615, 95% confidence interval (95%CI) was 1.487-8.785, P = 0.000], APACHE II score (OR = 4.697, 95%CI was 1.933-11.416, P = 0.000), endotoxemia (OR = 4.577, 95%CI was 1.883-11.123, P = 0.000), and cerebral hemorrhage volume (OR = 4.039, 95%CI was 1.662-9.816, P = 0.000) were the risk factors for CMODS in patients with acute cerebral hemorrhage. Taking the above risk factors as predictive variables, a nomogram prediction model was established. The verification results of the nomogram model showed that the C index was 0.804 (95%CI was 0.768-0.841), and the calibration curve was close to the ideal curve with good fit (P > 0.05). ROC curve results showed that the sensitivity and specificity of the nomogram model in predicting CMODS in patients with acute cerebral hemorrhage were 76.92%, 86.57%, respectively, and the area under the ROC curve (AUC) was 0.855 (95%CI was 0.776-0.935). Diabetes mellitus, APACHE II score, endotoxemia and intracerebral hemorrhage are risk factors for CMODS in patients with acute cerebral hemorrhage. The risk prediction model based on these risk factors is effective in evaluating the risk of CMODS in patients with acute cerebral hemorrhage.

Inpatient Satisfaction with the Quality of Services in Rehabilitation Hospital at Saudi Arabia: A retrospective study

Inpatient Satisfaction with the Quality of Services in Rehabilitation Hospital at Saudi Arabia: A retrospective study

Demographic Profile and Clinical Characteristics of Adults with Down Syndrome in North-Eastern Romania.

(1) Background: Down syndrome is characterized by physical abnormalities, intellectual disability (ID), and specific patterns of other health issues. Additionally, individuals with DS are known to experience premature aging and early onset of certain age-related medical conditions. These conditions are linked to higher incident disability and reduced survival rates compared to the general population. (2) Methods: Between July 2022 and February 2024, we conducted a prospective, observational study in the Cardiovascular Rehabilitation Clinic at Iasi Clinical Rehabilitation Hospital. The study included 28 patients diagnosed with Down Syndrome and a control group. Interdisciplinary interventions were tailored to address the needs of a complex patient, incorporating cardiological, endocrinological, genetical, biological and developmental support. Data on physical health, cognitive development, and psychosocial well-being were collected. (3) Results: Our DS group consisted of 11 (39%) females and 17 (61%) males. Their age ranged from 20 to 55 years with a mean of 28.07 ± 9.51. All patients were unmarried, living in urban areas, without a partner but with family support. In the study sample, 96.4% of participants had three or more comorbidities. (4) Conclusions: The high prevalence of multimorbidity, combined with little medication, contributes to a high level of clinical complexity, which appears to be similar to the one of the older non-trisomic population. As individuals with Down syndrome transition into adulthood, they may require a more comprehensive and holistic approach to their healthcare.

BLADDER score: evaluating a tool to support urinary diagnostic and antibiotic stewardship in hospitalized adults.

Antibiotic overuse for asymptomatic bacteriuria is common in older adults and can lead to harmful outcomes including antimicrobial resistance. Our objective was to evaluate the impact of a simple scoring tool onurine culturing and antibiotic prescribing for adults with presumed urinary tract infections (UTI). Quasi-experimental study using interrupted time series with segmented regression to evaluate urine culturing and urinary antibiotic use and length of stay (LOS), acute care transfers, and mortality 18 months before and 16 months after the intervention. 134-bed complex continuing care and rehabilitation hospital in Ontario, Canada. Nurses, nurse practitioners, physicians, and other healthcare professionals. A multifaceted intervention focusing on a 6-item mnemonic scoring tool called the BLADDER score was developed based on existing minimum criteria for prescribing antibiotics in patients with presumed UTI. The BLADDER score was combined with ward- and prescriber-level feedback and education. Before the intervention, the mean rate of urine culturing was 12.47 cultures per 1,000 patient days; after the intervention, the rate was 7.92 cultures per 1,000 patient days (IRR 0.87; 95% CI, 0.67-1.12). Urinary antibiotic use declined after the intervention from a mean of 40.55 DDD per 1,000 patient days before and 25.96 DDD per 1,000 patient days after the intervention (IRR 0.68; 95% CI, 0.59-0.79). There was no change in mean patient LOS, acute care transfers, or mortality. The BLADDER score may be a safe and effective tool to support improved diagnostic and antimicrobial stewardship to reduce unnecessary treatment for asymptomatic bacteriuria.

A qualitative study of stressors faced by older stroke patients in a convalescent rehabilitation hospital.

This study aimed to explore the stressors experienced by older patients with stroke in convalescent rehabilitation wards in Japan. Semi-structured interviews were conducted with four stroke patients aged > 65 years who experienced a stroke for the first time in their lives. The interviews were analyzed using the Steps for Coding and Theorization method for qualitative data analysis. The results of the qualitative analysis demonstrated that patients experienced specific stressors, such as, difficulty in movement of the paralyzed hand, fear of stroke recurrence, and dietary problems. Some stressors were manageable through healthcare professionals' active and sensitive communication strategies. These stressors were derived from the theoretical framework of "stressors related to hospitalization" and "stressors related to the illness". Additional stressors emerged from the interaction between these two types within the theoretical framework. The results of this study contribute to a deeper understanding of the specific stressors experienced by older stroke patients during the recovery process.

Dietary intake and related factors in inpatient pressure ulcer patients at Ho Chi Minh City Hospital Rehabilitation – Professional Diseases

A cross-sectional study was undertaken from February to May 2023 at the Ho Chi Minh City Hospital Rehabilitation – Professional Diseases to describe dietary intake and related factors in inpatient pressure ulcer patients at Ho Chi Minh City Hospital Rehabilitation – Professional Diseases. The findings indicated that the dietary consumption of these patients was below the advised nutritional standards, with an average energy intake of 1406.6 kcal/day. Among the patients participating in the study, 11.3% met the recommended requirements, and 23.9% exceeded the recommended requirements. Among the nutrients analyzed, lipids had the highest compliance with recommended levels at 22.5%, while zinc was the least compliant at only 1.4%. Vitamins C, E, and K were notably below the recommended intake levels. Significant variances were observed in the intake of vitamin E across different age groups and vitamin B1 in relation to receiving nutritional counseling (p &lt; 0.05). The study also identified significant differences in nutrient intake among different BMI-based nutritional status groups, particularly in fiber, vitamin B1, B2, B9, and C intake (p&lt;0.05). Given the direct impact of dietary intake on the progression of disease, hospitalization costs, and treatment success, conducting dietary assessments emerges as a crucial step for nutritional advice and enhancing adherence to dietary guidelines among patients. The study underscores the 24 hour recall method is a valuable tool for assessing dietary intake in individuals suffering from pressure ulcers.

Nutritional status and related factors in inpatient pressure ulcer patients at Ho Chi Minh City Hospital Rehabilitation – Professional Diseases in 2023

A cross-sectional study was conducted at the Ho Chi Minh City Hospital Rehabilitation – Professional Diseases from February to May 2023 to describe nutritional status and related factors in inpatient pressure ulcer patients at Ho Chi Minh City Hospital Rehabilitation – Professional Diseases in 2023. The study focus on the prevalence of malnutrition and the relationship between malnutrition status based on SGA with demographic characteristics, pathology, and clinical laboratory parameters in inpatients with pressure ulcers at the hospital. The study results showed that the prevalence of malnutrition using the SGA method was 92.7%, while using anthropometric BMI was 15.6%. There was a statistically significant difference in the prevalence of malnutrition according to SGA with age groups, length of hospital stays, and stage of pressure ulcers (p &lt; 0.05). Malnutrition is a common issue among patients with pressure ulcers, thus early detection of nutritional status is crucial for developing intervention plans, counseling, and individualized nutritional care for patients.

Time Course Effects of Kinesio Taping in Knee Osteoarthritis Patients

Background: Knee osteoarthritis is a common musculoskeletal disorder in the elderly, characterized by cartilage loss leading to pain, stiffness, and restricted movement. Kinesiotaping has been suggested as a therapeutic approach to reduce pain and improve functional outcomes in knee osteoarthritis patients. Objective: This study aimed to compare the effects of quadriceps and patellar kinesiotaping applied for different durations (24, 48, and 72 hours) on pain, balance, and functional performance in patients with knee osteoarthritis. Methods: A randomized clinical trial was conducted from March to September 2020 at the Railway General Hospital, Rawalpindi, and Abasyn Rehabilitation Center, Islamabad. Forty-eight patients with knee osteoarthritis (grades 2-3) were randomly assigned to three groups: Group A (kinesiotaping for 24 hours), Group B (kinesiotaping for 48 hours), and Group C (kinesiotaping for 72 hours). All participants also received conventional therapy, including hot pack application, quadriceps strengthening exercises (15 repetitions × 3 sets), and stretching exercises (5 repetitions with a 10-second hold × 3 sets). Pain, balance, and functional performance were assessed at baseline, post-intervention, and one week later using the Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Functional Reach Test (FRT), and Time Up and Go Test (TUG). Data were analyzed using SPSS version 25, with intragroup comparisons conducted using the Wilcoxon signed-rank test and intergroup comparisons using the Kruskal-Wallis test. A p-value of less than 0.05 was considered statistically significant. Results: Significant reductions in pain were observed across all groups (p &lt; 0.05), with the most notable improvement in Group C (72 hours), where NPRS scores decreased from a median of 2 (IQR 1.75) at baseline to 1 (IQR 1) at follow-up (p &lt; 0.05). However, no significant improvements were noted in balance or functional performance across the groups, as indicated by FRT, WOMAC, and TUG scores (p &gt; 0.05). Conclusion: Kinesiotaping significantly reduces pain in knee osteoarthritis patients, particularly when applied for 72 hours, but does not appear to significantly impact balance or functional performance. These findings suggest that kinesiotaping is effective for short-term pain management, though additional interventions may be necessary to improve functional outcomes.

The Long-Term Impact of COVID-19 on Disability after Post-Acute Rehabilitation: A Pilot Study.

Background: The long-term effect of the 2019 coronavirus (COVID-19) pandemic is not fully known. Severe cases of COVID-19 have resulted in disability that can be assessed in a biopsychosocial manner with the International Classification of Functioning, Disability and Health with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) questionnaire. This study aimed to evaluate the long-term effects on disability of COVID-19 three years after post-acute rehabilitation using WHODAS 2.0. Methods: This single-center cohort study included patients with severe COVID-19 who underwent immediate post-discharge post-acute rehabilitation intervention. Three years later, patients were assessed via telephone using the WHODAS 2.0 questionnaire. Results: Of the 69 patients identified in the hospital database, 27 responded. A total of 16 patients refused to respond due to emotional distress. The mean age was 63.4 ± 8.6 years, 81.5% were independent in the community, 55.3% had been previously admitted to the ICU, and the median rehabilitation hospitalization duration was 18 (11.5,24) days. Comorbidities included type 2 diabetes mellitus (DM) (55.5%), grade 2 high blood pressure (62.9%), pressure ulcers (37%), peripheral neurologic deficits (62.9%), and central neurological deficits (14.8%). ICU admission was significantly correlated with advanced rehabilitation needs (measured by the level of the rehabilitation (p < 0.01) and longer hospitalizations (measured by total days in the hospital (p < 0.001). The overall disability score was 35.09%, significantly influenced by DM and central neurological deficits. Conclusions: Central neurological deficits and DM are associated with higher disability scores. Tailored rehabilitation programs, ongoing medical assessment, integrated care models, and patient education are essential for improving long-term outcomes after COVID-19 disease.

Venous thromboembolism: exploring incidence and utility of screening in individuals with dual diagnosis.

The development of venous thromboembolism (VTE) is a common complication following spinal cord injury (SCI) and brain injury (BI), leading to significant morbidity and mortality. The purpose of this study was to explore the incidence of VTE in patients with the dual diagnosis (DD) of SCI and concomitant BI using ultrasonography. Retrospective study. Acute rehabilitation hospital. Thirty-one individuals admitted for DD rehabilitation who were routinely screened for VTE with ultrasound on admission. Not applicable. Retrospective chart review was performed to identify whether patients were found to have DVT or PE at the following three time points: in acute care prior to admission to rehabilitation, at time of admission diagnosed via screening examination, and after admission to rehabilitation during the inpatient stay via post screening examinations. Retrospective chart review was also performed to identify incidence of bleeding. 67.7% of individuals were found to have DVTs at any timepoint. Of these DVTs, 22.6% were identified in acute care, 48.4% on admission to rehabilitation, and 16.1% during the course of rehabilitation stay. Of those who were placed on therapeutic anticoagulation due to admission diagnosis of VTE, 25% developed recurrent DVT and 12.5% had bleeding complications. No cases of PE were observed in this study population. This study found a high incidence of DVT for the DD population at all three timepoints with a high proportion identified via screening ultrasonography on admission to rehabilitation. Further research is needed to investigate the incidence of VTE and utility of screening ultrasonography in this population.

Perceived severity and Barriers to Health Promotion of Male addicts in Early Recovery from Drug Use Disorder

Background: Drug addiction remains a significant public health issue globally, with substantial personal and societal impacts. Effective treatment and health promotion behaviors are crucial for recovery. Specific Background: In Iraq, the context of addiction treatment and the factors influencing health promotion behaviors among male addicts are underexplored. Knowledge Gap: There is limited understanding of the perceived severity and barriers to health promotion behaviors among male addicts in drug addiction centers in Iraq. Aims: Aims to assess the perceived severity and barriers to health promotion behavior among male addicts with a drug use disorder. Methods: A descriptive study design was utilized, with a convenience sample of 100 male individuals aged 15 to 45 from the Al-Ataa Hospital for Addiction and Psychological Rehabilitation. Data were collected via a questionnaire comprising socio-demographic characteristics and scales measuring beliefs regarding addiction. Cronbach's alpha for the perceived barriers and severity scales were 0.789 and 0.881, respectively. Results: The average participant age was 28 years, with 49% single, 71% living in lower-class neighborhoods, and 72% voluntary admissions. A significant relationship was found between educational level and health beliefs (p=0.00). The study revealed a high-level assessment of perceived severity and a moderate-level assessment of perceived barriers. Novelty: This study highlights the significant impact of educational level on health beliefs among male addicts, a relatively unexplored area in the region. Implications: The findings suggest that increasing awareness among patients and their families, establishing specialized hospitals, developing targeted policies, and leveraging media can enhance addiction treatment. This research underscores the need for comprehensive approaches involving various stakeholders to address drug addiction effectively. Highlights: High Perceived Severity: Addicts show high severity awareness. Education Impact: Significant link between education and health beliefs. Policy Recommendations: Establish specialized hospitals, targeted policies, media involvement. Keywords: drug addiction, health promotion, perceived barriers, perceived severity, Iraq

Perceived Relational Empathy and Resilience in People with Spinal Cord Injury at the End of Acute Care: A Cross-Sectional Study.

In patients with spinal cord injury (SCI), patient-reported outcomes (PROMs) and experience of care measures (PREMs) are extremely relevant for the prognosis. However, there is a paucity of research on these topics. We conducted a cross-sectional study to investigate the relationships between these patient outcomes and other demographic and clinical variables in adult SCI patients discharged from the intensive care unit of an Italian tertiary rehabilitation hospital. We administered the Consultation and Relational Empathy (CARE) for perceived relational empathy, the Spinal Cord Independence Measure III self-report (SCIM-SR) for functional autonomy, the Numeric Rating Scale (NRS) for pain, and the Connor-Davidson Resilience Scale (CD-RISC-10) for resilience. Study participants consisted of 148 adults with SCI; 82.4% were male, with a mean age of 49.9 years (SD = 16.6). The lesion was traumatic in 82.4% and complete in 74.3% of cases. The median length of hospital stays was 35 days (interquartile range-IQR = 23-60). Perceived relational empathy was positively associated with resilience (r = 0.229, p = 0.005) and negatively associated with the length of the stay and lesion completeness. Resilience had a weak negative association with pain (r = -0.173, p = 0.035) and was unrelated to other variables. Clinicians should consider the routine assessment of PREMs and PROMs in order to personalize post-discharge therapeutic plans and identify appropriate measures to ensure continuity of care.

Improving oxygenation in a patient with respiratory failure due to morbid obesity by applying airway pressure release ventilation: a case report

IntroductionMorbidly obese patients occasionally have respiratory problems owing to hypoventilation. Airway pressure release ventilation is one of the ventilation settings often used for respiratory management of acute respiratory distress syndrome. However, previous reports indicating that airway pressure release ventilation may become a therapeutic measure as ventilator management in morbid obesity with respiratory failure is limited. We report a case of markedly improved oxygenation in a morbidly obese patient after airway pressure release ventilation application.Case reportA 50s-year-old Asian man (body mass index 41 kg/m2) presented with breathing difficulties. The patient had respiratory failure with a PaO2/FIO2 ratio of approximately 100 and severe atelectasis in the left lung, and ventilator management was initiated. Although the patient was managed on a conventional ventilate mode, oxygenation did not improve. On day 11, we changed the ventilation setting to airway pressure release ventilation, which showed marked improvement in oxygenation with a PaO2/FIO2 ratio of approximately 300. We could reduce sedative medication and apply respiratory rehabilitation. The patient was weaned from the ventilator on day 29 and transferred to another hospital for further rehabilitation on day 31.ConclusionAirway pressure release ventilation ventilator management in morbidly obese patients may contribute to improving oxygenation and become one of the direct therapeutic measures in the early stage of critical care.