https://www.archives-pmr.org/article/S0003-9993(16)30041-7/pdf

Poststroke Aphasia Frequency, Recovery, and Outcomes: A Systematic Review and Meta-Analysis

Corticosteroid injections for shoulder pain

Research findings concerning burnout prevalence rate among nurses from the medical area are contradictory. The aim of this study was to analyse associated factors, to determine nurse burnout levels and to meta-analyse the prevalence rate of each burnout dimension. A systematic review, with meta-analysis, was conducted in February 2018, consulting the next scientific databases: PubMed, CUIDEN, CINAHL, Scopus, LILACS, PsycINFO and ProQuest Health & Medical Complete. In total, 38 articles were extracted, using a double-blinded procedure. The studies were classified by the level of evidence and degrees of recommendation. The 63.15% (n = 24) of the studies used the MBI. High emotional exhaustion was found in the 31% of the nurses, 24% of high depersonalisation and low personal accomplishment was found in the 38%. Factors related to burnout included professional experience, psychological factors and marital status. High emotional exhaustion prevalence rates, high depersonalisation and inadequate personal accomplishment are present among medical area nurses. The risk profile could be a single nurse, with multiple employments, who suffers work overload and with relatively little experience in this field. The problem addressed in this study influence the quality of care provided, on patients’ well-being and on the occupational health of nurses.

https://www.mdpi.com/1660-4601/15/12/2800/pdf

Levels of Burnout and Risk Factors in Medical Area Nurses: A Meta-Analytic Study

Background Posterior fossa strokes, particularly those related to basilar occlusion, pose a high risk for progression and poor neurological outcomes. The clinical history and examination are often not adequately sensitive or specific for detection. Study Objectives Because this population stands to benefit from acute interventions such as intravenous and intra-arterial tissue plasminogen activator, mechanical thrombectomy, and intensive monitoring for neurologic deterioration, this study examined the sensitivity of non-contrast head computed tomography (NCCT) for diagnosing posterior fossa strokes in the emergency department. Methods This study analyzed a prospectively collected database of acute ischemic stroke patients who underwent head NCCT within 30 h of symptom onset and who were subsequently found to have a posterior fossa infarct on brain magnetic resonance imaging (MRI) performed within 6 h of the NCCT. Results There were 67 patients identified who had restricted diffusion on MRI in the posterior fossa. The National Institutes of Health Stroke Scale (NIHSS) scores ranged from 0 to 36, median 3. Only 28 patients had evidence of infarction on the initial NCCT scan. The timing of NCCT scans ranged from 1.2 to 28.9 h after symptom onset. The sensitivity of NCCT was 41.8% (95% confidence interval 30.1–54.4). The longest period of time between symptom onset and a negative NCCT with a subsequent positive diffusion-weighted imaging MRI was 26.7 h. Conclusions Head NCCT imaging is frequently insensitive for detecting posterior fossa infarction. Temporal evolution of strokes in this distribution, coupled with beam-hardening artifact, may contribute to this limitation. When a posterior fossa stroke is suspected and the NCCT is non-diagnostic, MRI is the preferred imaging modality to exclude posterior fossa infarction.

Comparative Sensitivity of Computed Tomography vs. Magnetic Resonance Imaging for Detecting Acute Posterior Fossa Infarct

Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management.

Treatment Strategy for Irreparable Rotator Cuff Tears

Objective. Very few studies have investigated the predictive value of functional outcome, social outcome and discharge destination in patients with cerebrovascular accident (CVA) with aphasia. The aim of this study was to verify whether aphasia is predictor for outcome in patients with stroke with aphasia.Methods. The study was carried out in 262 patients with primary diagnosis of CVA and aphasia, included over a 6-year period (2001–2007): 131 with and 131 without aphasia. Statistically significant variables at the univariate regression analysis were submitted to the multivariate analysis. Backward stepwise regression analysis was applied to predict final motor-Functional Independence Measure (FIM), effectiveness in motor-FIM, final cognitive-FIM score and effectiveness in cognitive-FIM and discharge destination. Independent variables were age, gender, aphasia, stroke type, stroke lesion size, comorbidity, bladder catheter, motor function, trunk control test, initial motor-FIM and committed caregiver iden...

/pdf/predicting-outcome-after-stroke-the-role-of-aphasia-zt44zketlm.pdf

Predicting outcome after stroke: the role of aphasia.

Aim
The aim of this prospective study was to evaluate the effect of corticosteroids intra-articular injections on pain in patients with rotator cuff tear (RCT), and to identify predictors for pain outcomes.

Methods
A total of 60 patients with RCT were enrolled. All patients underwent rehabilitation; 20 patients received a single intra-articular injection of 40 mg triamcinolone acetonide and 20 patients had a repeat injection at a 21-day interval. Backward stepwise regression analysis was used to predict effectiveness and improvement of pain. The independent variables were age, sex, symptom duration, tear size, passive range of motion (ROM), active ROM, non-steroidal anti-inflammatory drugs request, pain at rest, number of triamcinolone injections and severity of osteoarthritis at admission.

Results
At 3 and 6 months, patients who received triamcinolone had higher effectiveness and improvement in pain during activities and pain at night than those of control group. At the 3-month interval post-therapy, active ROM was the only predictor for effectiveness in pain during activity, effectiveness in pain at night and improvement in pain at night. Six months after therapy, active ROM was a predictor for improvement in pain at night. Age was a predictor for effectiveness in pain at night, whereas tear size of RCT was a predictor for effectiveness and improvement in pain during activity.

Conclusions
Corticosteroids can relieve pain in RCT. Active ROM is the most important predictor of pain outcomes. This finding can be useful to physicians when deciding on the type of patients who might best benefit from intra-articular injections of corticosteroids. Geriatr Gerontol Int 2013; 13: 993–1001.

Corticosteroids injection in rotator cuff tears in elderly patient: pain outcome prediction.

Background and aims: There are few studies on the functional outcome of patients with supratentorial (STS) and infratentorial stroke (ITS). They lead to conflicting conclusions and do not define the role of motor deficits on functional recovery of STS and ITS patients. We wished to investigate this. Methods: The study was carried out on 90 consecutive patients admitted to our Rehabilitation Department with clinical evidence of acute cerebrovascular accident. Neuroimaging data, clinical evidence, and the National Institute of Health Stroke Scale (NIH) were used to select two groups of patients: 1) 45 patients with supratentorial stroke lesion (STS group), 2) 45 patients with infratentorial stroke lesion (ITS group). The STS group included patients with hemiparesis, and the ITS group patients with ataxia. Patients were evaluated through the NIH, Fugl-Meyer scale, Klockgether score, CIRS, Trunk Control Test (TCT), Lindmark scale, Barthel index, and Katz index, at both admission and discharge. Results: At admission, there were no differences between the STS and ITS groups in disability or average Barthel, Lindmark and Katz scores. At discharge, the Katz index average scores were significantly higher (p=0.000) and disability was lower (p=0.002) in ITS patients. The efficiency in Lindmark, Barthel and Katz scores of group ITS was significantly greater than that of STS patients (p=0.003, p=0.030 and p=0.000, respectively). The final Katz score was correlated (Spearman rank method) with initial TCT (p=0.000), onset to admission interval (p=0.019) and initial NIH (p=0.044) in the STS group. Final BADL score was correlated only with initial TCT (p=0.000) in the ITS group. Conclusions: Our data seem to indicate that STS has a worse rehabilitative prognosis than ITS, and that hemiparesis is more difficult to rehabilitate than ataxia.

Rehabilitative outcome in supratentorial and infratentorial stroke: the role of motor deficits.

Aim Few data exist about walking and motility after infratentorial stroke (IS). The aim of this study was to objectively quantify pre-rehabilitation and post-rehabilitation walking and mobility in a group of IS patients admitted for inpatient rehabilitation and to determine factors influencing functional outcomes. Materials and methods Seventy-two patients with IS were selected on the basis of clinical criteria and computer tomography (CT) images. Mean age was 76.5 +/- 10 (31 men and 41 women). The stroke was ischemic in 55 patients and hemorrhagic in 17 Walking (Lindmark scale), mobility (Rivermead Mobility Index) (RMI) and stroke severity (National Institute of Health Stroke Scale) (NIH) were evaluated in all patients at admission to study and at discharge. Results Before rehabilitation 1.4% of patients were independent in walking and 23.7% were over 75th percentile in RMI. After rehabilitation, 80.5% of the patients were able to walk independently and 84.7% were over 75th percentile of mobility. Age, onset to admission interval, and extent of the stroke did non correlate with Lindmark and RIM. Lindmark and RMI were correlated only with NIH. Patients with higher NIH score (NIH+) had significantly worse walking capacity and mobility than patients with lower NIH score (NIH-) before and after rehabilitation. Moreover, in patients NIH+ length of rehabilitation therapy was significantly longer compared to patients NIH-. In addition, patients NIH+ had efficiency in walking and in mobility significantly lower than patients NIH-. Conclusions The study shows that: (1) IS patients have a significant functional recovery in walking and mobility after rehabilitation, (2) stroke severity is related with walking and mobility.

Walking and mobility before and after rehabilitation in patients with infratentorial stroke.

Predictors of balance in older hip fracture patients undergoing standard motor rehabilitation

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