Effect of number of home exercises on compliance and performance in adults over 65 years of age.
BACKGROUND AND PURPOSE: There is limited research on the effects of the number of exercises a person is told to perform on compliance and performance, as defined by cueing requirements, correct alignment, and quality of movement. Some studies of medication suggest that compliance decreases as the number of medications increases. The purpose of this study was to determine whether older adults comply and perform better (ie, requiring less cueing, exhibiting correct alignment, and exhibiting controlled, coordinated, and continuous movements) when they are asked to do 2, 5, or 8 exercises. SUBJECTS: Subjects were 11 women and 4 men, aged 67 to 82 years (X=72.8), who were living independently in their communities. METHODS: Subjects were randomly prescribed 2, 5, or 8 general strengthening home exercises. They were instructed on their exercises at an initial session and asked to record the number of repetitions performed each day in a self-report exercise log. At a return session 7 to 10 days later, subjects were scored on their performance of the prescribed exercises using a newly designed assessment tool. RESULTS: The group that was prescribed 2 exercises performed better, as defined by their performance tool score, than the group that was prescribed 8 exercises. The group that was prescribed 5 exercises was not different from the groups that performed 2 or 8 exercises. No differences were found among groups regarding the self-report measurement of compliance. There was a moderate correlation between performance scores and the self-report percentage rates. CONCLUSION AND DISCUSSION: Subjects who were prescribed 2 exercises performed better than subjects who were prescribed 8 exercises. The question of an optimal number of exercises to prescribe to elderly people warrants further study. (+info)
Back care instructions in physical therapy: a trend analysis of individualized back care programs.
BACKGROUND AND PURPOSE: The treatment of people with low back pain often includes giving a variety of instructions about back care. The objective of our study was to explore the content and sequence of these instructions. SUBJECTS: Our database contained information on 1,151 therapy sessions for 132 patients who were treated by 21 therapists. METHODS: Hierarchical linear modeling was used to establish trends in instructions during the course of treatment. Instructions were measured by means of a registration form. RESULTS: Pain management instructions were given at the start of treatment and then decreased in later sessions. Instructions about taking care of the back in daily activities followed the same course. Exercise instructions were introduced after the start of treatment and were spread evenly across the visits. The number of recommendations about general fitness decreased during treatment. CONCLUSION AND DISCUSSION: The majority of back care instructions were spread evenly across therapy visits. Relatively little variation in instructions among patients was seen, which may indicate a lack of individualization of the back care programs. (+info)
Clinical complaints: a means of improving quality of care.
OBJECTIVES: To establish the reasons for clinical complaints, complainants' feelings about the original incident, and their motivation in complaining. DESIGN: Postal questionnaire survey. SETTING: 24 hospitals in North West Thames region. SUBJECTS: 1007 complainants who had written to 20 hospitals between 1 January 1992 and 30 June 1993 about a complaint involving a clinical incident. MAIN MEASURES: Personal details, the nature of the complaint, the complainant's reaction to the original incident, the quality of the explanation at the time of the incident, the reasons for making a complaint, and what would have prevented the incident. RESULTS: 491 completed questionnaires were received (response rate 49%). Complaints arose from serious incidents, generally a clinical problem combined with staff insensitivity and poor communication. Clinical complaints were seldom about a clinical incident alone (54; 11%); most (353; 72%) included a clinical component and dissatisfaction with personal treatment of the patient or care. In all, 242(49%) complainants reported a need for additional medical treatment, 206(42%) reported that the patient's condition had worsened as a result of treatment, and 175(36%) that side effects had been experienced. In 26(5%) cases the patient had died. Complainants' primary motive was to prevent recurrence of a similar incident. Lack of detailed information and staff attitude were identified as important criticisms. CONCLUSIONS: The emphasis must be on obtaining a better response to complaints at the clinical level by the staff involved in the original incident, not simply on adjusting the complaints procedure. Staff training in responding to distressed and dissatisfied patients is essential, and monitoring complaints must form part of a more general risk management programme. (+info)
Clinical improvement with bottom-line impact: custom care planning for patients with acute and chronic illnesses in a managed care setting.
A fully capitated, integrated healthcare delivery system endeavored to improve the care of its sickest members. A computer algorithm severity index that encompassed a 1-year history of hospitalization and adjusted for inclusion of a variety of chronic conditions was calculated on the basis of clinical and administrative claims databases for the entire membership of the healthcare system. Monthly updated lists were produced to find patients with acute and chronic illnesses. These patients accounted for one-fourth of hospital admissions and almost half of inpatient days, but they numbered less than 1% of system membership. Each listed person, regardless of age or diagnosis, had a custom care plan formulated by nurses in consultation with the primary care physician and involved specialists. Plan development featured in-home assessments in most instances and incorporated a variety of ancillary services, telephone and home-care follow-up, and strategies to increase continuity and access to care. Patient-reported functional status was obtained at establishment of the care plan and periodically thereafter in expectation of raising the cross-sectional mean values of the population. Three months after initiation of the program, the expected winter hospitalization peak did not occur, and utilization tended to be lower in subsequent months. Inpatient admissions among members with acute and chronic illnesses decreased 20%, and inpatient days decreased 28% from baseline levels. Among the subset of seniors in the population, inpatient days decreased 37%. Net financial impact was a medical expenditure decrease of more than 5% from 1995 levels. On a population basis, functional status was raised, and the acuity of patients' conditions and need for inpatient hospital care were reduced. (+info)
Arrested eruption of the permanent lower second molar.
The incidence of retention/impaction of the permanent lower second molar (M2inf) lies between 0.6/1000 and 3/1000. Therefore, the purpose of the present study was to investigate the craniofacial morphology, the frequency of dental anomalies and the inclination of the affected M2inf and the adjacent first molar in patients with arrested eruption of M2inf. The overall goal was to elucidate the aetiology of arrested tooth eruption and to present the characteristics of these patients in order to improve diagnosis and treatment planning. Radiographic material (profile radiographs and orthopantomograms) from 19 patients (nine females and 10 males; 13-19 years of age at the time of referral) were analysed. The ages of the patients when profile radiographs were taken for cephalometric analysis varied from 8 to 16 years. The study shows that this group of patients, compared with a reference group, had an increased sagittal jaw relationship (Class II). Specifically, the mandibular prognathism was less, the mandibular gonial angle smaller, the mandibular alveolar prognathism enlarged and the maxillary incisor inclination less than in the reference group. Furthermore, this group of patients had a more frequent occurrence of morphological tooth anomalies, such as root deflections, invaginations, and taurodontism. However, none of the patients with arrested eruption of M2inf had agenesis of the lower third molar. The study did not reveal an association between the degree of inclination of the M2inf and that of the first molar in the same region. The results of this investigation show that conditions such as the craniofacial morphology and deviations in the dentition are associated with arrested eruption of M2inf. Therefore, it is important to evaluate these conditions in future diagnosis and treatment planning of patients with arrested eruption of M2inf. (+info)
A new technique of surface anatomy MR scanning of the brain: its application to scalp incision planning.
BACKGROUND AND PURPOSE: Surface anatomy scanning (SAS) is an established technique for demonstrating the brain's surface. We describe our experience in applying SAS with superposition of MR venograms to preoperative scalp incision planning. METHODS: In 16 patients, scalp incision planning was done by placing a water-filled plastic tube at the intended incision site when we performed SAS using half-Fourier single-shot fast spin-echo sequences. Two-dimensional phase-contrast MR angiograms were obtained to demonstrate the cortical veins and then superimposed upon the SAS images. The added images were compared with surgical findings using a four-point grading scale (0 to 3, poor to excellent). RESULTS: In each case, neurosurgeons could easily reach the lesion. Surgical findings correlated well with MR angiogram-added SAS images, with an average score of 2.56. CONCLUSION: Our simple technique is a useful means of preoperatively determining brain surface anatomy and can be used to plan a scalp incision site. (+info)
Core guidelines for the discharge home of the child on long-term assisted ventilation in the United Kingdom. UK Working Party on Paediatric Long Term Ventilation.
Paediatric home ventilation is a feasible option and can be successful in a wide range of conditions and ages. Advances in ventilator technology and an ethos of optimism for home care has increased the possibilities for discharging chronically ventilated children from intensive care units and acute medical beds. With careful planning the process can succeed, but difficulties often thwart the responsible team, especially when attempting discharge for the first time. These core guidelines aim to assist a smooth, swift and successful transfer. They were developed by a working party of interested professionals spanning a wide range of health care disciplines and represent a synthesis of views accumulated from the experiences of individual teams throughout the UK. Three case scenarios provide further illustrative detail and guidance. (+info)
Calcification in chronic maxillary sinusitis: comparison of CT findings with histopathologic results.
BACKGROUND AND PURPOSE: It is important to differentiate fungal from nonfungal sinusitis in order to determine the optimal treatment for chronic sinusitis. The purpose of this study was to describe the CT findings of calcifications in chronic fungal and nonfungal maxillary sinusitis. METHODS: Five hundred ten patients with pathologically proved chronic maxillary sinusitis were studied with unenhanced CT before undergoing sinonasal surgery. In 36 patients, the CT scans were reviewed retrospectively to ascertain the shape and location of intrasinus calcifications. RESULTS: Calcifications were found in 20 (51%) of 39 patients with fungal sinusitis and in 16 (3%) of 471 patients with nonfungal sinusitis. Direct histopathologic correlation was performed in two of 16 patients with nonfungal sinusitis who had intrasinus calcification. The location of intrasinus calcification was central in 95% of the patients with fungal sinusitis and peripheral in 81% of those with nonfungal sinusitis. Although calcifications with a nodular or linear shape were seen in both fungal and nonfungal sinusitis, fine punctate type calcifications were seen only in those with fungal sinusitis (50%) and round or eggshell type calcifications only in those with nonfungal sinusitis (19%). CONCLUSION: Intrasinus calcifications are different in location and shape between fungal and nonfungal maxillary sinusitis. Although intrasinus calcification is uncommon in nonfungal sinusitis, the CT finding of intrasinus calcification may be helpful for differentiating fungal from nonfungal maxillary sinusitis. (+info)