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SAGE Open Medical Case Reports 2021Cancer rehabilitation can be preventive, restorative, supportive, and palliative. The rehabilitation goals change as the cancer pathway alters. Following any treatment...
INTRODUCTION
Cancer rehabilitation can be preventive, restorative, supportive, and palliative. The rehabilitation goals change as the cancer pathway alters. Following any treatment for head and neck cancer, a physiatrist plays an essential role in preventing various complications and helping patients to mitigate impairments and restore function, optimizing their quality of life.
CASE DESCRIPTION
This is a case study of a 56-year-old man with squamous cell cancer of the tongue managed with glossectomy, chemotherapy, and radiotherapy. He also has a remote history of acute myeloid leukemia involving the central nervous system, presenting with seizure and infective endocarditis. He underwent a sternotomy and an aortic valve replacement. His postoperative course was complicated by sternal infection, bradycardia with agonal breathing, and a weak pulse, for which the patient underwent cardiopulmonary resuscitation and achieved return of spontaneous circulation and was intubated and managed with antibiotics. He had a tracheostomy and underwent aggressive pulmonary toileting and suctioning in acute care. As the patient stabilized, he was transferred to in-patient rehabilitation.
INTERVENTIONS
While the patient was in the in-patient rehabilitation unit, cancer rehabilitation issues were addressed, including swallowing, pulmonary rehabilitation, management of upper-extremity deep venous thrombosis and infection, bowel and bladder issues, skin care, and evaluation of mental status. The patient's cancer prognosis and future were discussed in collaboration with his oncologist. He was discharged with a palliative care plan.
CONCLUSION
This report illustrates the significance of physical medicine and rehabilitation in management of cancer patients, as most cancer patients experience some deconditioning that results in physical challenges. As the prognosis for most types of cancers improves, it becomes more important to ensure that all cancer patients regain maximum function in the broadest sense to maximize their independence.
PubMed: 34262771
DOI: 10.1177/2050313X211025450 -
Materia Socio-medica Mar 2022Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic...
BACKGROUND
Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic antidepressants, gabapentinoids and potent opioids are first-line treatments and are highly effective, but their use is limited due to adverse effects that may occur in elderly patients with significant medical comorbidities or interaction due to multiple drug use. There are no head-to-head comparisons of non medical treatments. Dry needling appears comparable to conventional physical therapy for treating PHN.
OBJECTIVE
Our aim is to determine the incidence of PHN in our population and to compare the treatments in patients with postherpetic neuralgia.
METHODS
A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices (dermatologist and physiatrist) and representing 5600 people. We analyzed a retrospective 37 case with PNH of 170 herpes zoster patient admmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. Dry needling and physical therapy methods applied in addition to medical treatment in PHN treatment were compared.
RESULTS
In patients with postherpetic neuralgia, both dry needling therapy group and physical therapy group LANSS scores decreased significantly in the first week and in the third week compared to baseline. Dry needling therapy group has also similar results in VAS scores in the first and third week. But in physical therapy group, the VAS score did not show a significant decrease in the first week compared to the baseline, but it decreased significantly in the third week.
CONCLUSION
PHN is a complex, difficult to treat and severe neuropathic pain that affects patients' daily function and quality of life. Various agents and methods are available to relieve the symptoms of PHN. This study shows as both physical therapy and dry needling therapy are effective treatment for postherpetic nevralgia..
PubMed: 35801062
DOI: 10.5455/msm.2022.33.55-59 -
American Journal of Physical Medicine &... May 2023Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout.
INTRODUCTION
Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout.
OBJECTIVE
The aim of the study is to identify characteristics of the work environment associated with professional fulfillment and burnout among US physiatrists.
DESIGN
Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists.
SETTING
Online interviews, focus groups, and survey were conducted.
PARTICIPANTS
The participants are physiatrists in the American Academy of Physical Medicine and Rehabilitation Membership Masterfile.
MAIN OUTCOME MEASURES
Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.
RESULTS
Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items, Cronbach α = 0.86); integration of physiatry into patient care (3 items, Cronbach α = 0.71); personal-organizational values alignment (3 items, Cronbach α = 0.90); meaningfulness of physiatrist clinical work (6 items, Cronbach α = 0.90); teamwork and collaboration (3 items, Cronbach α = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age, 52 yrs; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio = 1.96; 95% confidence interval = 1.45-2.69), integration of physiatry into patient care (odds ratio = 1.77; 95% confidence interval = 1.32-2.38), personal-organizational values alignment (odds ratio = 1.92; 95% confidence interval = 1.48-2.52), meaningfulness of physiatrist clinical work (odds ratio = 2.79; 95% confidence interval = 1.71-4.71), and teamwork and collaboration score (odds ratio = 2.11; 95% confidence interval = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment.
CONCLUSIONS
Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in US physiatrists. Variation in these domains by practice setting and subspecialty suggests that tailored approaches are needed to promote professional fulfillment and reduce burnout among US physiatrists.
Topics: Humans; Female; United States; Middle Aged; Male; Burnout, Professional; Physiatrists; Physicians; Surveys and Questionnaires; Personal Satisfaction
PubMed: 37076955
DOI: 10.1097/PHM.0000000000002216 -
Seminars in Oncology Nursing Feb 2020To define radiation fibrosis and radiation fibrosis syndrome; review the basics of radiotherapy, the pathophysiology of radiation injury, and the principles of clinical... (Review)
Review
OBJECTIVES
To define radiation fibrosis and radiation fibrosis syndrome; review the basics of radiotherapy, the pathophysiology of radiation injury, and the principles of clinical evaluation and management of the common late effects resulting from radiation therapy for cancer treatment.
DATA SOURCES
Peer-reviewed journal articles, book chapters, Internet.
CONCLUSION
There is no cure for radiation fibrosis syndrome, but supportive treatment of its clinical sequelae can potentially result in improved function and quality of life.
IMPLICATIONS FOR NURSING PRACTICE
The sequelae of radiation fibrosis syndrome can often be improved with early detection and supportive care by a multidisciplinary team including cancer rehabilitation physiatrists, oncologists, oncology nurses, nurse practitioners, physical therapists, occupational therapists, and speech and language pathologists.
Topics: Adult; Aged; Aged, 80 and over; Cancer Survivors; Female; Humans; Male; Middle Aged; Neoplasms; Quality of Life; Radiation Pneumonitis; Radiotherapy; United States
PubMed: 32008860
DOI: 10.1016/j.soncn.2019.150982 -
Recenti Progressi in Medicina Feb 2020Fast-track knee arthroplasty is a multidisciplinary perioperative approach resulting in decreased convalescence, better patient satisfaction, and reduced hospital costs.... (Review)
Review
Fast-track knee arthroplasty is a multidisciplinary perioperative approach resulting in decreased convalescence, better patient satisfaction, and reduced hospital costs. However, considerable room for improvement had been recently identified in the postoperative portion of care. Which prognostic factors, in that phase, can improve the outcomes of rehabilitation, in terms of functional recovery and patient satisfaction, how, and for whom? Surgeons, physiatrists and physiotherapists from our high-volume hospital identified five postoperative issues as significantly prognostic to rehabilitation. An electronic research was performed to look for the associate keywords. 30 papers were included in the synthesis. Clinical, social, psychological and logistical prognostic factors are fundamental to improve patient education and compliance. Intensive and early physiotherapy when possible; standard exercise programs based on patient cluster of characteristics; discharge planning according to functional, psychological and social criteria; patient motivation; use of psychopharmacological treatment; substantial connection between institutions; are postoperative prognostic factors which play a major impact on the effectiveness of rehabilitation after fast-track TKA. Future research should identify recovery curves to predict, track and understand specific outcomes to specific cohorts of patients, in order to refer them to the most suitable rehabilitative modality and setting.
Topics: Arthroplasty, Replacement, Knee; Humans; Length of Stay; Patient Discharge; Patient Satisfaction; Prognosis; Recovery of Function
PubMed: 32089557
DOI: 10.1701/3309.32798 -
Cureus Aug 2022Objective We aim to assess the awareness and evaluation pattern among physiatrists regarding cancer rehabilitation and associated barriers to access. Design The present...
Objective We aim to assess the awareness and evaluation pattern among physiatrists regarding cancer rehabilitation and associated barriers to access. Design The present study is a cross-sectional study in the Physical Medicine and Rehabilitation (PMR) Association Annual Meeting in Puerto Rico that used a 10-item questionnaire to summarize physiatrists' clinical patterns with their persons diagnosed with cancer (PDWCs). Results Thirty-eight (66.7%) participants answered they received minimal to no education about cancer rehabilitation benefits. Cancer patients represented 10% or less of the weekly patient load for 47 (82.5%) physiatrists surveyed. The most common type of cancer encountered was breast cancer for the management of adverse effects. Twenty-nine (50.9%) physiatrists answered that a multifactorial barrier was the cause for limited services within this population group. All participants agreed that rehabilitation is at least sometimes beneficial for cancer patients, and 54 (94.7%) believed these services are needed. Conclusion Although rehabilitation specialists learn about the benefits of rehabilitation for PDWCs, there continues to be a limited number of PDWCs evaluated, mainly due to poor access, lack of information about cancer rehabilitation, and economic difficulties. Further efforts should be made to emphasize the importance of integrating rehabilitation techniques in the care of PDWCs.
PubMed: 36196316
DOI: 10.7759/cureus.28622 -
PM & R : the Journal of Injury,... May 2023Multiple national studies suggest that, among physicians, physiatrists are at increased risk for occupational burnout.
INTRODUCTION
Multiple national studies suggest that, among physicians, physiatrists are at increased risk for occupational burnout.
OBJECTIVE
To identify characteristics of the work environment associated with professional fulfillment and burnout among U.S. physiatrists.
DESIGN
Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists.
SETTING
Online interviews, focus groups, and survey.
PARTICIPANTS
Physiatrists in the AAPM&R Membership Masterfile.
MAIN OUTCOME MEASURES
Burnout and professional fulfillment assessed using the Stanford Professional Fulfillment Index.
RESULTS
Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items; Cronbach's alpha = 0.86); integration of physiatry into patient care (3 items; Cronbach's alpha = 0.71); personal-organizational values alignment (3 items; Cronbach's alpha = 0.90); meaningfulness of physiatrist clinical work (6 items; Cronbach's alpha = 0.90); teamwork and collaboration (3 items; Cronbach's alpha = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age 52 years; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.45-2.69), integration of physiatry into patient care (OR = 1.77; 95% CI = 1.32-2.38), personal-organizational values alignment (OR = 1.92; 95% CI = 1.48-2.52), meaningfulness of physiatrist clinical work (OR = 2.79; 95% CI = 1.71-4.71) and teamwork and collaboration score (OR = 2.11; 95% CI = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment.
CONCLUSIONS
Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in U.S. physiatrists. Variation in these domains by practice setting and subspecialty suggests tailored approaches are needed to promote professional fulfillment and reduce burnout among U.S. physiatrists.
Topics: Humans; Female; Middle Aged; Male; Burnout, Professional; Physiatrists; Physicians; Personal Satisfaction; Surveys and Questionnaires
PubMed: 36794660
DOI: 10.1002/pmrj.12961 -
American Journal of Physical Medicine &... Oct 2021Individuals living with cerebral palsy or spina bifida are at heightened risk for a number of chronic health conditions, such as secondary comorbidities, that may... (Comparative Study)
Comparative Study
BACKGROUND
Individuals living with cerebral palsy or spina bifida are at heightened risk for a number of chronic health conditions, such as secondary comorbidities, that may develop or be influenced by the disability, the presence of impairment, and/or the process of aging. However, very little is known about the prevalence and/or risk of developing secondary comorbidities among individuals living with cerebral palsy or spina bifida throughout adulthood. The objective of this study was to compare the prevalence of psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity among adults with and without cerebral palsy or spina bifida.
METHODS
Privately insured beneficiaries were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for cerebral palsy or spina bifida (n = 29,841). Adults without cerebral palsy or spina bifida were also included (n = 5,384,849). Prevalence estimates of common psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity (≥2 conditions) were compared.
RESULTS
Adults living with cerebral palsy or spina bifida had a higher prevalence of all psychological disorders and psychological multimorbidity (14.6% vs. 5.4%), all cardiometabolic disorders and cardiometabolic multimorbidity (22.4% vs. 15.0%), and all musculoskeletal disorders and musculoskeletal multimorbidity (12.2% vs. 5.4%), as compared with adults without cerebral palsy or spina bifida, and differences were to a clinically meaningful extent.
CONCLUSIONS
Adults with cerebral palsy or spina bifida have a significantly higher prevalence of common psychological, cardiometabolic, and musculoskeletal morbidity and multimorbidity, as compared with adults without cerebral palsy or spina bifida. Efforts are needed to facilitate the development of improved clinical screening algorithms and early interventions to reduce risk of disease onset/progression in these higher risk populations.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
CME OBJECTIVES
Upon completion of this article, the reader should be able to: (1) List the main categories of morbidity that present with higher risk in adults with cerebral palsy and spina bifida; (2) Discuss the potential impact of multimorbidity on 'early aging' in adults living with cerebral palsy and spina bifida; and (3) Describe challenges that adults with cerebral palsy and spina bifida have in obtaining appropriate health care to address prevention and treatment of multimorbidity.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Adolescent; Adult; Aged; Cardiovascular Diseases; Cerebral Palsy; Cross-Sectional Studies; Female; Humans; Male; Mental Disorders; Middle Aged; Multimorbidity; Musculoskeletal Diseases; Prevalence; Retrospective Studies; Spinal Dysraphism; Young Adult
PubMed: 34001837
DOI: 10.1097/PHM.0000000000001787 -
World Neurosurgery Nov 2019In our discipline, neurosurgery, the role of the leader has evolved and has been complemented by the collaboration of specific professionals of different disciplines,... (Review)
Review
In our discipline, neurosurgery, the role of the leader has evolved and has been complemented by the collaboration of specific professionals of different disciplines, aiming at the overall result of curing people and defeating the disease. Indeed, the multidisciplinary cooperation and the innovative strength of a team composed of different specialists such as radiologists, anesthesiologists, pathologists, molecular biologists, geneticists, oncologists, psychologists, physiatrists, physiotherapists, neurologists, engineers, mathematics, statisticians, and economists, greatly has changed the way we see the patient and treat pathology: from a single to multiperspective vision, thus generating a synergy that improves the surgeon's and the overall work. An old African adage goes like this: "If you want to go fast, go alone. if you want to go far, go together," which in our opinion fully summarizes the sense of our contribution on the state of the art in neurosurgical contemporary practice.
Topics: Humans; Leadership; Nervous System Diseases; Neurosurgeons; Neurosurgery; Neurosurgical Procedures; Patient Care Team
PubMed: 31382066
DOI: 10.1016/j.wneu.2019.07.196 -
Frontiers in Neurology 2021In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and... (Review)
Review
In Japan, the national medical insurance system and long-term care insurance (LTCI) system cover rehabilitation therapy for patients with acute, convalescent, and chronic stroke. Medical insurance covers early and multidisciplinary rehabilitation therapy during acute phase hospitalizations. Patients requiring assistance in their activities of daily living (ADL) after hospitalization are transferred to kaifukuki (convalescent) rehabilitation wards (KRW), which the medical insurance system has also covered. In these wards, patients can receive intensive and multidisciplinary rehabilitation therapy to improve their ADL and transition to a smooth home discharge. After discharge from these hospitals, elderly patients with stroke can receive outpatient (day-care) rehabilitation and home-based rehabilitation using the LTCI system. The Japanese government has proposed building a community-based integrated care system by 2025 to provide comprehensive medical services, long-term care, preventive care, housing, and livelihood support for patients. This policy aims to promote smooth coordination between medical insurance services and LTCI providers. Accordingly, the medical insurance system allows hospitals to receive additional fees by providing patient information to rehabilitation service providers in the LTCI system. A comprehensive database on acute, convalescent, and chronic phase stroke patients and seamless cooperation between the medical care system and LTCI system is expected to be established in the future. There are only 2,613 board-certified physiatrists in Japan, and many medical schools lack a department for rehabilitation medicine; establishing such a department at each school is encouraged to teach students efficient medical care procedures, to conduct research, and to facilitate the training of personnel in comprehensive stroke rehabilitation.
PubMed: 35087461
DOI: 10.3389/fneur.2021.711470