Integration of rehabilitation and palliative care in cancer management:A futuristic model

It explores the integration of rehabilitation and palliative care in cancer management,advocating for a holistic approach that addresses the diverse needs of patients throughout their treatment journey.Traditional cancer care often prioritizes curative interventions at the expense of overall well-being,leading to a fragmented experience for patients.By combining rehabilitation-focused on restoring function and improving physical health-with palliative care-emphasizing symptom management and quality of life-healthcare providers can create a comprehensive support system.The essay highlights the importance of interdisciplinary collaboration among healthcare professionals,as well as the need for education and training to implement this integrated model effectively.Additionally,it addresses potential barriers such as funding limitations and institutional resistance.Ultimately,the integration of these two disciplines represents a critical evolution in cancer care,enhancing patient outcomes and ensuring that individuals receive compassionate,patient-centered support throughout their journey.

Personalized and continuous care intervention affects rehabilitation,living quality,and negative emotions of patients with breast cancer

BACKGROUND Breast cancer is among the most common malignancies worldwide.With progress in treatment methods and levels,the overall survival period has been prolonged,and the demand for quality care has increased.AIM To investigate the effect of individualized and continuous care intervention in patients with breast cancer.METHODS Two hundred patients with breast cancer who received systemic therapy at The First Affiliated Hospital of Hebei North University(January 2021 to July 2023)were retrospectively selected as research participants.Among them,134 received routine care intervention(routing group)and 66 received personalized and continuous care(intervention group).Self-rating anxiety scale(SAS),self-rating depression scale(SDS),and Functional Assessment of Cancer Therapy-Breast(FACT-B)scores,including limb shoulder joint activity,complication rate,and care satisfaction,were compared between both groups after care.RESULTS SAS and SDS scores were lower in the intervention group than in the routing group at one and three months after care.The total FACT-B scores and five dimensions in the intervention group were higher than those in the routing group at three months of care.The range of motion of shoulder anteflexion,posterior extension,abduction,internal rotation,and external rotation in the intervention group was higher than that in the routing group one month after care.The incidence of postoperative complications was 18.18%lower in the intervention group than in the routing group(34.33%;P<0.05).Satisfaction with care was 90.91% higher in the intervention group than in the routing group(78.36%;P<0.05).CONCLUSION Personalized and continuous care can alleviate negative emotions in patients with breast cancer,quicken rehabilitation of limb function,decrease the incidence of complications,and improve living quality and care satisfaction.

Value-based Practice:Integration of Cancer Rehabilitation and Palliative Care in Oncology Services

Value-based care model has been evolving to organize medical services around the patient and provide the full cycle of care for a medical condition.The full cycle of care model encompasses inpatient,outpatient,rehabilitation as well as supportive care such as palliative care and nutrition support.Cancer rehabilitation and palliative care have emerged as two important parts of value-based practice for oncology patients.More clinical evidence suggests that early intervention of oncology rehabilitation program and palliative care are likely to improve the patient outcome and reduce the overall medical cost for the patient and his or her family as well as for medical service providers.Although interest has been raised in Chinese oncologists,but effectiveness of incorporating these two services in clinical practices has not been adequately demonstrated.An understanding of scope of cancer rehabilitation and palliative care may help facilitate the integration of both into the oncology care continuum in efforts to improve patients'physical,psychological,cognitive,functional health and quality of life.

Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation

BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.

Effect of rapid rehabilitation nursing on improving clinical outcomes in postoperative patients with colorectal cancer

BACKGROUND Surgical resection is the cornerstone treatment for colorectal cancer.Rapid rehabilitation care predicated on evidence-based medical theory aims to improve postoperative nursing care,subsequently reducing the physical and mental traumatic stress response and helping patients who undergo surgery recover rapidly.AIM To assess the effect of rapid rehabilitation care on clinical outcomes,including overall postoperative complications,anastomotic leaks,wound infections,and intestinal obstruction in patients with colorectal cancer.METHODS We searched the PubMed,Web of Science,Embase,Elsevier Science Direct,and Springer Link databases from January 1,2010,to January 1,2024,to screen eligible studies on rapid rehabilitation care among patients who underwent colorectal cancer surgery.Patients were screened based on the inclusion and exclusion criteria.RevMan 5.4 software was used for statistical analysis of the data.RESULTS Twelve studies were enrolled,which included 2420 patients.The results showed that rapid rehabilitation care decreased the incidence of overall postoperative complications(OR:0.44,95%CI:0.26–0.74,P=0.002),anastomotic leaks(OR:0.68,95%CI:0.41–1.12,P=0.13),wound infections(OR:0.45,95%CI:0.29–0.72,P=0.0007),and intestinal obstruction(OR:0.54,95%CI:0.34–0.86,P=0.01)compared to conventional care.Further trials and studies are needed to confirm these results.CONCLUSION Rapid rehabilitation care decreased the occurrence of postoperative complications,anastomotic leaks,wound infections,and intestinal obstruction compared to conventional care in patients who underwent colorectal surgery.Therefore,promoting the application of rapid rehabilitation care in clinical practice cannot be overemphasized.

Examining older patient preferences for quality of care in postacute transition care and day rehabilitation programs

Background: Quality in health care has traditionally been determined based on clinical or health outcomes. However, these factors may not be the only aspects of health care that are important to patients. Within rehabilitation factors related to the process of care, the way in which rehabilitation services are delivered, may also be important to patients when defining quality of care. Objective: The purpose of this study was to examine and compare the preferences of older people receiving post-acute outpatient rehabilitation or residential intermediate (transition) care for alternative configurations of rehabilitation programs. Methods: A discrete choice experiment (DCE) was designed to elicit the preferences of older people for the design and delivery of post-acute rehabilitation programs. The participants were older adults (≥65 years) receiving post-acute outpatient rehabilitation or residential intermediate (transition) care in South Australia. Each participant was presented with a series of choice questions involving two hypothetical programs, the characteristics of which varied in every choice. Participants were then asked to select their preferred program. Results: Despite marked differences in case-mix and dependency levels, the preferences of the two groups were very similar, focusing on relationships and communication with health care professionals. Both groups demonstrated very strong preferences for the use of an electronic medical record and for receiving information about their treatment and progress via a meeting with a specialist physician and nurse. The outpatient rehabilitation group also exhibited a strong preference for a shared decision making model in relation to their future care needs. Conclusions: The findings highlight the commonality of preferences of older patients receiving post-acute services for the optimal configuration of rehabilitation services. Issues prioritised were service integration and access to senior medical and nursing staff. The study demonstrates the practicality and validity of DCEs to determine older people’s preferences in defining quality of care.

Comprehensive and personalized approach is a critical area for developing remote cardiac rehabilitation programs

In the evolving landscape of cardiac rehabilitation(CR),adopting digital technologies,including synchronous/real-time digital interventions and smart applications,has emerged as a transformative approach.These technologies offer realtime health data access,continuous vital sign monitoring,and personalized educational enhanced patient self-management and engagement.Despite their potential benefits,challenges and limitations exist,necessitating careful consideration.Synchronous/real-time digital CR involves remote,two-way audiovisual communication,addressing issues of accessibility and promoting home-based interventions.Smart applications extend beyond traditional healthcare,providing real-time health data and fostering patient empowerment.Wearable devices and mobile apps enable continuous monitoring,tracking of rehabilitation outcomes,and facilitate lifestyle modifications crucial for cardiac health maintenance.As digital CR progresses,ensuring patient access,equitable implementation,and addressing the digital divide becomes paramount.Artificial intelligence holds promise in the early detection of cardiac events and tailoring patient-specific CR programs.However,challenges such as digital literacy,data privacy,and security must be addressed to ensure inclusive implementation.Moreover,the shift toward digital CR raises concerns about cost,safety,and potential depersonalization of therapeutic relationships.A transformative shift towards technologically enabled CR necessitates further research,focusing not only on technological advancements but also on customization to meet diverse patient needs.Overcoming challenges related to cost,safety,data security,and potential depersonalization is crucial for the widespread adoption of digital CR.Future studies should explore integrating moral values into digital therapeutic relationships and ensure that digital CR is accessible,equitable,and seamlessly integrated into routine cardiac care.Theoretical frameworks that accommodate the dynamic quality of real-time monitoring and feedback feature of digital CR interventions should be considered to guide intervention development.

Aging Characteristics and Layout Planning of Old-age Care Facilities in the Downtown Area of Nanchang City

Compared to the situation of population aging and the elderly aging, the development of oldage undertaking in Nanchang is still undeveloped in that the old-age care industry lags behind the urban renewal speed and the objective needs of aging. Apart from discussions on the composition of elderly population and the status quo of aging, this paper took the institutional old-age care in the downtown area of Nanchang for example, explored problems in the current institutional old-age care facilities through field investigation, and proposed suggestions for the layout planning of old-age care facilities in the study area.

Impact of early intensive rehabilitation care in patients undergoing cardiac surgery in a single center:a quasi-experimental study

Objective To evaluate the impact of early intensive rehabilitation care in adults undergoing cardiac surgery.Methods This was a quasi-experimental study using assessor blinding in 252 cardiac surgery patients recruited from Fuwai Hospital.Participants awaiting cardiac surgery were divided into the experiment group and the control group.The control group received routine rehabilitation care postoperatively,including the exercise training,deep breathing exercises,nutrition direction,medication instruction,psychological education,pain management and sleep conditioning.

Inter-organizational cooperation: A rehabilitation project based on cooperation between health care and three social service agencies

Purpose: Cooperation between organizations is an often-suggested remedy for handling unsolved borderland problems. However, actual projects aiming at cooperation are seldom very successful. The purpose here is to highlight obstacles related to cooperation between different organizations based on a case study of a rehabilitation project where health care and several social service organizations (social insurance, social welfare, and the local employment agency) were involved. Data were gathered through participation and interviews. Findings: It seems that efficient cooperation requires an understanding of the participating organizations’ differences in work logic as well as work practices. Furthermore, only certain fairly standardized “normal” problems may be handled through organized cooperation while non-routine exceptional problem requires a more fully integrated work organization. Implications: Obstacles to cooperation are highlighted and ways to improve the possibilities of cooperation between organizations are suggested although such possibilities are generally hampered by differences in work logic.

An Integrated Rehabilitation Model: An Ideal Framework for Limiting Health Care Costs

The financial crisis has caused a severe limitation of resources for the public health service and rehabilitation. The proposal of integrated diagnosis and treatment in rehabilitation, involving the introduction of new therapeutic models alongside orthodox models, could lead to a reduction in health care costs through better patient compliance. In rehabilitative assistance in health care, the limiting of financial resources can be simplified, given its multifaceted nature and the need to integrate clinical experience with research. In addition, the phases of rehabilitative recovery do not focus on organ damage, but improved participation and the reduction of disability. For this reason, we have considered incorporating narrative based medicine (NBM) and Psycho-Neuro-Immuno-Endocrinology (PNEI) in the rehabilitation process through an empathetic approach, taking evidence based medicine (EBM) into account, thus creating a “framework” of reference. Managing patients through this “framework” would be a move towards an integrated model of care that could lead to a reduction in health care costs, given the aging population and the rise in patients with chronic pain. The decision to modify health care in rehabilitative assistance through a new “framework” will require time, organizational capacity and experimentation, but may represent the appropriate response for an improved quality of life for patients and a better allocation of resources.

Motion-Sensing Based Management System for Smart Context-Awareness Rehabilitation Healthcare

In this paper, a motion-sensing based management system for smart context-awareness rehabilitation healthcare including various balance exercise is built by the integration of the physiological sensing and feedback coaching. The home-end system can not only provide the exercise coaching instruction, the balance stability analysis, and the motion similarity analysis in real-time, but also simultaneously transmit the user image, exercise skeleton streaming, center of pressure (COP), center of gravity (COG) and physiological information to the telecare-end center. According to the combination of the home-end and the telecare-end as well as the real-time care management of one-to-multiple personal balance exercise monitor, this system can provide user various personalized balance exercise prescription and cardiac rehabilitation coaching in an effectiveness rehabilitation exercise environment. Therefore, via this tele-system, the spinocerebellar ataxia (SCA) patients in balance rehabilitation stage not only can be monitored execution status of the rehabilitation exercise prescription, but also can be long-term monitored and evaluated the predicted goal of the rehabilitation exercise balance stability in order to improve patient’s compliance.

Quality-Oriented Climate and Service Quality Among Healthcare Providers： Evidence From a Rehabilitation Center in Italy

The importance of quality in service provision is widely recognized in health service research. However, a limited number of studies have investigated antecedents of quality in healthcare service provision. This article tries to shed further light on this under-researched field. Specifically, the aim of this study is to verify the relationship between the quality-oriented climate and service quality as perceived by employees. The study was conducted in a private non-profit Rehabilitation Centre in Italy using a questionnaire administered to all healthcare workers. The questions focused on perceptions of quality-oriented climate （priorization of quality care, social cooperation, and exchange）, four different connotations of the quality in healthcare provision （provision of high quality service, adequacy of time spent with patients, freedom in clinical decisions, and continuing relationships with patients）, as well as on respondents＇ background. Of the 248 healthcare workers, 183 completed the questionnaire. Hierarchical regression analysis was used to study the relationship between quality-oriented climate and outcome variables （quality in healthcare provision）. The results suggest that a quality-oriented climate does explain service quality in Healthcare settings： When an organization has implemented a quality-oriented climate, the service care provided by healtheare workers can determine an increase for three of the four investigated aspects of quality service provision （quality of care, freedom to make clinical decisions to meet patients＇ needs, and continuing relationships with patients）. The paper demonstrates that the offer of quality services involves in a different way the various healthcare professionals and/or management staff. This research provides interesting findings for healthcare manager in Health Service settings regarding the management of a quality-oriented process of service provision.

Evidence-based Care for Rehabilitation Nursing Effect of Patients with Patellar Fracture

Objective.To analyze the effect of applying evidence-based care in rehabilitation nursing effect of patients with patellar fractures.Methods.A total of 54 patients with patellar fractures were randomly selected from the hospital.The diagnosis and treatment time were from the beginning of July 2018 to end of June 2019.The digital table grouping was adopted to divide patients into two groups with each group consists of 27 patients with this disease.Both groups underwent routine nursing and the experimental group with increased evidence-based care.Results.Compared with the control group,the knee function evaluation,complications and nursing satisfaction of the experimental group were more ideal,and the difference was statistically significant(P<0.05).Conclusion.Evidence-based care in rehabilitation nursing of patients with patellar fracture can obtain ideal nursing effect.

Analysis of home care-based multi-level old-age service system

With the deepening of China＇s aging, China＇s social pension problem more obvious each day, and gradually become the focus of attention of the whole society. On the one hand, China entered the aging society, old-age needs to grow exponentially. The sixth national census shows that in our country, the population aged 60 and 13.26% of the total population over the total number of 179 million, 65 years and older the proportion of 8.87% of the total population, the absolute number of nearly 120 million. Hundreds of millions of older age groups will produce a growing demand for care services, which is the original old-age service system and the whole economic and social development is a huge pressure. On the other hand, with the economic and social transformation, the traditional model of family pension has been unable to adapt to the profound changes in modem employment, family structure, the concept of retirement, since most parts of China, ＂old before getting ricE＂ the situation, how to solve the elderly the pension problem is related to the overall situation of China＇s economic and social development, related to the overall situation of building a harmonious society in China. Under current national conditions, the emphasis on the development of a single individual body to meet the growing demand for pension service is not realistic, we must mobilize the enthusiasm of all aspects of the element, multi-service integration of resources subject to their commitment to a different responsibilities and tasks provide a full range of care services according to different types, different levels of the actual needs of the older age groups. On the aging problem is that the whole community to face, you need to multi-government body, families, communities, institutions combine effectively starting from the actual needs of the elderly population, according to the financial assistance, life care, spiritual consolation three set the specific needs of services, through a government-led, home-based care services, community care services for the core and supplementary services for institutions focused on pension and other means to provide a full range of pension services.

Construction of Xi'an ecological old-age care community in the new urbanization

The new urbanization is an important carrier of ecological civilization construction, and ecological old-age care is the concrete manifestation of the perfect combination of the two, the proper meaning of the new urbanization connotation and an inevitable trend of its development. Based on the analysis of the connotation and relationship between the new urbanization and ecological old-age care, together with the current situation and existing problems of the current nursing institutions and ecological old-age care in Xi'an area, this paper discusses the major issues that should be noticed when constructing the ecological old-age care community in Xi'an and three main construction modes.

The Experience and Enlightenment of the Development of Old-age Care Services in Russia

Through the analysis of the history and current situation of Russia＇s old-age care services system, this paper analyzes and studies the old-age care services system in Russia. By means of law and social policy, Russia can promote the active participation of the elderly in politics, economy, culture and other activities to promote the positive image of the elderly. The active aging policy in Russia and the development trend of the old-age care service to promote the social adaptation and re-employment of the elderly are of positive significance to the development of our country＇s old-age care service.

Effects of early rehabilitation therapy on patients with mechanical ventilation

BACKGROUND: For patients in intensive care unit(ICU), mechanical ventilation is an effective treatment to survive from acute illness and improve survival rates. However, long periods of bed rest and restricted physical activity can result in side effects. This study aimed to investigate the feasibility of early rehabilitation therapy in patients with mechanical ventilation.METHODS: A randomized controlled trial was carried out. Sixty patients, with tracheal intubation or tracheostomy more than 48 hours and less than 72 hours, were admitted to the ICU of the Affiliated Hospital of Medical College, Qingdao University, from May 2010 to May 2012. These patients were randomly divided into a rehabilitation group and a control group. In the rehabilitation group, rehabilitation therapy was performed twice daily, and the training time and intensity were adjusted according to the condition of the patients. Early rehabilitation therapy included heading up actively, transferring from the supine position to sitting position, sitting at the edge of the bed, sitting in chair, transferring from sitting to standing, and ambulating bedside. The patient's body mass index, days to first out of bed, duration of mechanical ventilation, length of ICU stay, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality of patients were all compared between the rehabilitation group and the control group. The differences between the two groups were compared using Student's t test.RESULTS: There was no significant difference in body mass index, APACHE II score, highest FiO2, lowest PaO2/FiO2 and hospital mortality between the rehabilitation group and the control group(P>0.05). Patients in the rehabilitation group had shorter days to first out of bed(3.8±1.2 d vs. 7.3±2.8 d; P=0.00), duration of mechanical ventilation(5.6±2.1 d vs. 12.7±4.1 d; P=0.005) and length of ICU stay(12.7±4.1 d vs. 15.2±4.5 d; P=0.01) compared with the control group.CONCLUSION: Early rehabilitation therapy was feasible and effective in improving the outcomes of patients with mechanical ventilation.

The Practice of Physical Medicine and Rehabilitation in subSaharan Africa and Antarctica：A White Paper or a Black Mark？

Objective:To explore the practice of PM&R in subSaharan Africa and Antarctica.Method:Medline searches,membership data searches,fax survey of medical schools,Internet searches,and interviews with experts.Result:The continents are dissimilar in terms of climate and government.However both Antarctica and subSaharan Africa have no PM&R training programs,no professional organizations,no specialty board requirements,and no practicing physicians in the field.Since there is no known disabled child on Antarctica and adults are airlifted to world-class health care,the consequences of this deficit are minimal there.However the 788,000,000 permanent residents of subSaharan Africa including approximately 78 million persons with disability are left unserved.Conclusion:Antarctica is doing fine.Africa is in a crisis.Local medical schools,hospitals doctors,and persons with disability;along with foreign volunteers,aid groups,and policymakers can impact the crisis.However government-specifically national ministries of health-is ultimately responsible for the health and wellbeing of citizens.

Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.