Clinical value of precise rehabilitation nursing in management of cerebral infarction

BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.

Impact of community-based rehabilitation on quality of life and self-esteem of persons with physical disabilities and their family members

Objective:Community-based rehabilitation(CBR)is a strategy by which persons living with disability(PWDs)access comprehensive rehabilitation services with limited evidence regarding its impact on the quality of life(QOL)and self-esteem(SE)of PWDs and their family members.This study compared the QOL and SE of Nigerian PWDs in communities with and without a CBR programme(CBR and non-CBR respectively),and the family quality of life(FQOL)of their family members.Methods:Cross-sectional study involving 2604 PWDs(1302 in CBR and 1302 in non-CBR);5208 family members of PWDs(2604 in CBR and 2604 non-CBR),recruited from four randomly selected geo-political zones in Nigeria,purposive/consecutive selection of eight CBR programmes,PWDs and their family members(CBR and non-CBR).Outcomes assessed using Rosenberg Self-Esteem Scale(RSES),World Health Organization Quality of Life Instrument-short form(WHOQOL-BREF)and Beach Centre Family Quality of Life Instrument(BCFQOL).Mann-Whitney U test and Spearman's rank order correlation were used to analyse data at P<0.05.Results:PWDs in CBR scored higher in all domains of WHOQOL-BREF(P<0.0001 in all cases)and RSES than non-CBR group(P<0.0001).The CBR families scored significantly higher than non-CBR families in all domains(P<0.05)except Emotional Well-Being of the BCFQOL.The CBR group scores on Psychological and Social Health domains of the WHOQOL-BREF showed significant positive correlation with CBR families'Family Interaction(P=0.06)and Parenting(P=0.07)domains and total FQOL(P=0.07).Conclusion:Community-based rehabilitation positively impacted on SE and QOL of PWDs and their family members.

Optimizing pain management in elderly patients post-knee surgery:A novel collaborative strategy

Total knee replacement,a common surgery among the elderly primarily necessitated by osteoarthritis,replaces the damaged knee joint with an artificial one.Given the aging population and the increasing prevalence of such surgeries,the article highlights the critical need for effective postoperative care strategies.This editorial provides an overview of rehabilitation care for pain in elderly knee replacement patients,emphasizing the importance of a multimodal approach to postoperative recovery.Furthermore,the article advocates for a patient-centered,comprehensive rehabilitation regimen that enhances recovery and quality of life in elderly patients undergoing knee replacement surgery.

Optimization of transdisciplinary management of elderly with femur proximal extremity fracture:A patient-tailored plan from orthopaedics to rehabilitation

Fractures of femur proximal extremity(FFPE)are the most common fragility fractures requiring hospitalization,with a high risk of mortality,low independence in the activities of daily living and severe consequences on healthrelated quality of life.Timing for surgery has a key role in the management of elderly patients with FFPE as recommended by the Australian and New Zealand guidelines and the National Institute for Health and Care Excellence guidelines.Early surgery(within 48 h from hospital admission)allows significant benefits in terms of lower rates of postoperative complications and risk of death and can provide better functional outcomes.Therefore,time for surgery could be considered as a comorbidity marker.The choice between conservative or surgical approach surprisingly seems to be still not strongly supported by available literature,but it seems that both 30 d and 1 year risk of mortality is higher with the conservative treatment rather than with surgery.In light of these considerations,the optimization of FFPE management care is mandatory to improve functional outcomes and to reduce sanitary costs.Albeit it is widely accepted that transdisciplinary approach to patients suffering from FFPE is mandatory to optimize both short-term and long-term outcomes,the feasibility of a comprehensive approach in clinical practice is still a challenge.In particular,the large variability of figures involved could be considered both a resource and an additional disadvantage taking into account the difficulty to coordinate multidisciplinary approach covering care in all settings.Therefore,the aim of the present article was to summarize current evidence supporting transdisciplinary management of patients with FFPE,highlighting the benefits,feasibility and limitations of this approach.

Impaired motor control after sport-related concussion could increase risk for musculoskeletal injury:Implications for clinical management and rehabilitation

This review presents a conceptual framework and supporting evidence that links impaired motor control after sport-related concussion(SRC)to increased risk for musculoskeletal injury.Multiple studies have found that athletes who are post-SRC have higher risk for musculoskeletal injury compared to their counterparts.A small body of research suggests that impairments in motor control are associated with musculoskeletal injury risk.Motor control involves the perception and processing of sensory information and subsequent coordination of motor output within the central nervous system to perform a motor task.Motor control is inclusive of motor planning and motor learning.If sensory information is not accurately perceived or there is interference with sensory information processing and cognition,motor function will be altered,and an athlete may become vulnerable to injury during sport participation.Athletes with SRC show neuroanatomic and neurophysiological changes relevant to motor control even after meeting return to sport criteria,including a normal neurological examination,resolution of symptoms,and return to baseline function on traditional concussion testing.In conjunction,altered motor function is demonstrated after SRC in muscle activation and force production,movement patterns,balance/postural stability,and motor task performance,especially performance of a motor task paired with a cognitive task(i.e.,dual-task condition).The clinical implications of this conceptual framework include a need to intentionally address motor control impairments after SRC to mitigate musculoskeletal injury risk and to monitor motor control as the athlete progresses through the return to sport continuum.

Community-Based Integrated Watershed Management

Community-based watershed management is different from the traditional natural resources management. Traditional natural resources management is a way from up to bottom, but the community-based watershed management is from bottom to up. This approach focused on the joining of different stakeholders in integrated watershed management, especially the participation of the community who has been ignored in the past. The purpose of this paper is to outline some of the important basic definitions, concepts and operational framework for initiating community-based watershed management projects and programs as well as some successes and practical challenges associated with the approach.

Community-Based Approach in the Prevention and Management of Flood Disasters in Babessi Sub-Division (Ndop Plain, North West Cameroon)

Flood is a recurrent natural disaster that has caused enormous human and material damage in many places and continues to hit local committees at an alarming rate. The need to setup permanent committees to prevent and manage flood disasters by local communities is therefore indispensable. In rural areas, the creation of such a structure is always a welcome relief to flood victims but it is often marred by numerous management problems. This study aimed to analyze the community-based approach in the prevention and management of flood disasters in Babessi Subdivision (North West Cameroon), to identify the causes of flood disasters and the preventive strategies used by this local community. A total number of 300 questionnaires as well as structured interviews were used to collect data in the field and the data were analyzed by simple descriptive statistics. The main results revealed that the main cause of flood disasters is heavy and consistent rainfall. Also, poor refuse disposal and drainage system management contribute to floods. The identification of areas likely to be affected by floods and preventing the riparian population from constructing houses along these areas especially beside the main rivers are the flood preventive measures adopted by the local flood management committee. The flood victims are reluctant to relocate to the settlement site earmarked by the Government, meanwhile, the local flood committee do not have the legal tools to forcefully relocate them. The population of Babessi needs to be sensitized on the impending dangers of flood hazard and be encouraged to participate in implementing the adopted strategies to prevent and manage subsequent flood disasters.

Research on Design and Management of Community-Based Ecotourism Model in Aksu-Zhabagly Nature Reserve of Kazakhstan

This study investigates the community-based ecotourism (CBE) model using a sample of the Aksu-Zhabagly nature reserve (NR). The aim is to propose a suitable CBE model for Aksu-Zhabgly nature-based tourism destinations by employing a combination of field observation, examination, evaluation, and SWOT analysis. The study determines the strategic suggestions for CBE model designing by the results of SWOT analysis. It concludes that convenient transportation and superior location, diversified wild animals and plants, rich in ethnocultural resources, traditional and tranquil life in a typical rural setting, hospitality and positive attitude of locals to tourism and great potential of the region for sustainable development of ecotourism are the strengths. At the same time, the far residential location from the provincial cities, low-quality service, outdated facilities and shortage of skilled employees in tourism management are the main weakness. Another group of constraints to tourism development is lack of tourism marketing and promotion agencies, lack of transparency, poor institution arrangement and corruption, and lack of preferential policies for CBE development. Finally, the paper recommends that economic development, environmental protection, culture and heritage, marketing and image, favorable political environment, and local residents’ empowerment are the main essential to effectively implement the sustainable development of CBE in the Aksu-Zhabagly tourist destination.

Disability management and rehabilitation for persons with multiple sclerosis

Multiple sclerosis is the commonest cause of chronic neurological disability in young adults. Patients typically have a normal life span, though with accrued time multiple disabilities with a significant impact on quality of life. This article presents the current literature on symptomatic treatment and rehabilitation for persons with multiple sclerosis. A comprehensive multidisciplinary approach addresses the acute, intermediate and long-term medical, psychological and social issues faced by these individuals. Prevention of medical complications, maintenance and restoration of functional independence, addressing psychosocial factors and issues relating to quality of life are integral to the rehabilitation processes.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Background: The community based management of severe acute malnutrition (CMAM) was introduced in Ghana in 2008 to manage cases of severe acute malnutrition (SAM) recorded at the community level. This study estimated the economic cost of the CMAM programme for children under-five in the Agona west municipality of Ghana. Methods: A retrospective cross sectional study that used a cost analysis design was employed to estimate the economic cost of the programme from the societal perspective. Household cost data from caregivers were obtained using a semi-structured questionnaire. That of programme cost data was obtained from document reviews as well as the use of semi-structured questionnaires and subsequent discussions with key personnel of the Ghana Health Service, Food and Nutrition Technical Assistance and UNICEF. One and multi-way sensitivity analyses were conducted to test how sensitive the cost estimates are to certain variations in the cost profiles. Results: The economic household cost of CMAM was estimated as $1905.32 ($47.63 per household) of which 79% was attributed to direct cost while the remaining 21% made up indirect cost. Programme economic cost of CMAM was estimated as $27633.5 (96% recurrent and 4% capital), with refresher training constituting majority of the cost (34%). The constituents of the total economic cost of the programme, estimated as $32214.56 are programme cost (86%), household costs (6%) and community volunteer cost (8%). Therefore, the economic cost of treating one SAM case using the CMAM protocol was estimated as $805.36. Conclusion: Although CMAM has proven to be an effective tool for the management of SAM, its associated costs are quite enormous when coverage levels (geographic) are high yet small number of cases are detected and treated. Therefore, it is prudent to implement several cost saving strategies such as a reduction in the number of days spent on trainings in order to reduce these costs.

Management of Spinal Osteochondrosis Rehabilitation Process

Background： Osteochondrosis of spine is the one of the most prevalent diseases among the all musculoskeletal conditions. Osteochondrosis is not a curable condition and its treatment/rehabilitation is a long-term process. The present work aims to assess clinical effectiveness and duration of outcomes of rehabilitation that includes complex and consequent methods （algorithm） of treatment. The pilot study has been continuing several years and now is going on. Methods： The subject were 220 patients, 122 females and 98 males, aged 50-65 （adherence to treatment 100%） with as reflex as well radicular syndromes in subacute phase. Informed consent was obtained from all patients. Rehabilitation process continued 2.5-3 months and its management included the following consequent methods： waist fixation, pain control with medication （NSAIDs and in some cases steroidal drugs）, iontophoresis with karipazim-20-25 sessions, after 8-10 sessions of the latter manual therapy was added-10-12 sessions, and kinesiotherapy （3 times per week） after 5 procedures. After pain management recommendation of daily life activity was given. Oral chondroprotectors after completion of a treatment were administered. Dynamic evaluation of subjective and objective symptoms, mobility and functional state of spine were done. Parameters were assessed before treatment, after 3 month and 1-3 years upon its completion. Results： Data were analyzed using SPSS program. Obtained results showed that after the first course of treatment （3 months） positive outcomes were observed in 198 patients （90%）, 22 （10%） of patients required the second course of rehabilitation. Stable outcome of treatment was maintained after 1 year in 204 patients （92.7%） and after 3 years in 196 patients （89%）. Conclusion： Approbated complex of treatment is established to be effective in rehabilitation of patients with lumbar osteochondrosis.

Community-based intervention of chronic disease management program in rural areas of Indonesia

Objective:This study evaluates the community-based intervention of chronic disease management(CDM)through the Integrated Non-Communicable Diseases Health Post(Posbindu-NCD)conducted by a community of health workers(CHWs)in Indonesia’s rural areas.Methods:A cohor t retrospective study evaluated 577 par ticipants from Posbindu-NCD in 7 public health centers(PHCs)in 2019.Activities of intervention of CDM for Posbindu-NCD was included,identified risk factors to NCDs,and provided counselling education and other follow-ups based on interviews and measurement results from the five Desk systems that recorded in a medical record as a form of the monthly activity report each the first month,the 6 months,and the 12th month.Results:There were statistically significant differences for alcohol consumed and diabetes mellites(χ^(2)=10.455;P=0.001).There were significant differences on gender(χ^(2)=3.963;P=0.047),on ethnicity(χ^(2)=19.873;P<0.001),and hypertension.In addition,there were also significant differences on ethnicity(χ^(2)=15.307;P<0.001),vegetable consumption(χ^(2)=4.435;P=0.035),physical exercise(χ^(2)=6.328;P=0.012),and the current diseases of hypercholesterolemia of par ticipants.Fur thermore,the survival rate among patients who have overweight,abdominal overweight,hyper tension,diabetes mellitus,and hypercholesterolemia increased among par ticipants who regularly visited Posbindu-NCD compared with the non-regularly one.Conclusions:The CDM program’s community-based intervention through Posbindu-NCD conducted by CHWs improved survival rates in Indonesia’s rural areas.Therefore,this program can be fur ther developed in conducting CDM in the community with the active involvement of CHWs so that the community becomes active regularly in par ticipating in Posbindu-NCD activities in rural areas of Indonesia.

A Creative Wedding Event Management for Sustaining Community-Based Eco-Tourism: A Case Study in Thailand

The research aims to propose a proper model for organizing a creative wedding event to boost Community-Based Eco-Tourism(CBET)in rural areas.It is participatory research.Site observation and in-depth interviews are 10 stakeholders from various organization;local people,the district sheriff,the provincial culture,the national park,the district municipality,the community-based tourism group,the wedding organizers and the educators from a wedding event in themed“Carry Love Covering the Forest”organized in Wiang Sa,Suratthani,the southern part of Thailand were applied.Thematic analysis was applied to analyze the data.The results found that the managing model for organizing an event tourism in Community-Based Eco-Tourism composes of three stages being pre-event,during-event,and after-event.The research provides a comprehensive understanding management model of CBET.The research makes contribution to develop and manage a new creative event to enhance positive impacts of community-based tourism to sustain,especially in eco-tourism destination.

“I Am Getting Healthier”. Perceptions of Urban Aboriginal and Torres Strait Islander People in a Chronic Disease Self-Management and Rehabilitation Program

Chronic disease is a main contributor to the disproportionately high burden of illness experienced by Aboriginal and Torres Strait Islander Australians. However, there are very few programs addressing chronic disease self-management and rehabilitation which are designed specifically for urban Aboriginal and Torres Strait Islander people. This paper aims to explore client and staff perceptions of the Work It out Program, a chronic disease rehabilitation and self-management program designed for urban Aboriginal and Torres Strait Islander people. The study used a mixed methods approach to explore the success, barriers and self-reported outcomes of the program. Quantitative data were collected through a structured survey, comprising social and demographic data. Qualitative data were collected through interviews using Most Significant Change theory. Twenty-eight participants were recruited, 6 staff and 22 clients (M = 7, F = 21) with an age range between 21 and 79 years of age (Mean = 59.00, SD = 17.63). Interviews were completed in 2013 across four Work It out locations in Southeast Queensland. Semi-structured interviews were conducted either individually or in groups of two or three, depending on the participants’ preference. Thematic analysis of the data revealed six main themes;physical changes, lifestyle improvements, social and emotional well-being, perceptions about the successful features of the program, perceived barriers to the program and changes for the future. This exploratory study found that clients and staff involved in the Work It out Program perceived it as an effective self-management and rehabilitation program for urban Aboriginal and Torres Strait Islander Australians. Further evaluation with a larger sample size is warranted in order to establish further outcomes of the program.

Multi-objective optimization in highway pavement maintenance and rehabilitation project selection and scheduling:A state-of-the-art review

The motivation for cost-effective management of highway pavements is evidenced not only by the massive expenditures associated with these activities at a national level but also by the consequences of poor pavement condition on road users.This paper presents a state-of-the-art review of multi-objective optimization(MOO)problems that have been formulated and solution techniques that have been used in selecting and scheduling highway pavement rehabilitation and maintenance activities.First,the paper presents a taxonomy and hierarchy for these activities,the role of funding sources,and levels of jurisdiction.The paper then describes how three different decision mechanisms have been used in past research and practice for project selection and scheduling(historical practices,expert opinion,and explicit mathematical optimization)and identifies the pros and cons of each mechanism.The paper then focuses on the optimization mechanism and presents the types of optimization problems,formulations,and objectives that have been used in the literature.Next,the paper examines various solution algorithms and discusses issues related to their implementation.Finally,the paper identifies some barriers to implementing multi-objective optimization in selecting and scheduling highway pavement rehabilitation and maintenance activities,and makes recommendations to overcome some of these barriers.

How to Effectively Detect and Manage People Living with HIV/AIDS in China:Establishment of a Community-based Model

This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were inter-viewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Coun-seling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some ex-isting problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the commu-nity-based VCT/PITC through 4 paths. Then we establish the community HIV health care center con-stituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.

A New Approach to Urban Rainwater Management

Based on an analysis of our research results and the main problems relating to urban rainwater treatment, we propose a new approach to urban rainwater management in China. The necessity and feasibility of such a new approach are discussed. From an ecological point of view all components of the global system, including residents living in cities, have the same right to enjoy rainwater. Therefore, urban rainwater should neither be simply drained as waste water, nor be completely harvested as a kind of resource. The objective of this new approach is to maintain the natural hydrological cycle in urban areas during urbanization. When necessary, it could also be used to regulate the amount of runoff, evaporation and infiltration in a city in order to rehabilitate the hydrological cycle given the local conditions. Three basic principles should be adopted in rainwater management, i.e., separation of rainfall from sewage, limited utilization and small and decentralized facilities. Four methods can be used for urban rainwater management: rainwater harvest, rainwater infiltration, rainwater storage and rainwater pipes. The natural hydrological cycle in urban areas could be rehabilitated through rainwater management, which is of great importance for sustainable development of our cities.

Management of Village Common Forests in the Chittagong Hill Tracts of Bangladesh: Historical Background and Current Issues in Terms of Sustainability

This study was conducted to investigate the historical management system of village common forests (VCF) in the Chittagong Hill Tracts (CHT) of Bangladesh and observe the current issues related to their sustainability. The study on historical context was based on secondary information to establish the linkages of VCF development and management in the CHT. Field visits to four VCF in the Bandarban Hill Districts were also conducted to cross check the information collected from secondary sources to observe the current status and management pattern of these VCF through semi-structured interviews, group discussion, key-informant interviews and biodiversity assessment. VCF in the CHT undoubtedly play an important role in biodiversity conservation and as well as supporting daily necessities of the community people. We found that VCF still are the source of fuel wood, herbs, roots, bamboo shoots, wild fruits, vines or leaves for cooking or medicinal use necessary to sustain the lives of the indigenous communities in the CHT. Field visits to different VCF show that the VCF are necessarily small in size (57 ha) and around 108 families are dependent on these community managed village forests. A total of 163 plant species from 60 families were also recorded from these VCF including some rare plant and animal species which are not usually found in the reserve forests and the un-classed state forests due to continued deforestation and land degradation. However, population pressure combined with improved marketing facilities, ignorance, over exploitation, personal greed, tenure insecurity, faulty government policies regarding settlement of land and breakdown of the traditional systems exerting pressures on these VCF and the overall condition of these important biodiversity rich areas are degrading or shrinking in size and number gradually. Recognizing the traditional and customary resource rights of the indigenous communities in the CHT, acknowledging resource management system, providing tenure security, encouraging communities through legal and financial incentives in protecting these VCF or any other state owned forest areas solely for the conservation of biodiversity following an intensive management plan, resolving long lasting land related conflicts, and at the same time upholding the spirit of CHT Peace Accord 1997 could be important policy tools for the sustainability of these VCF in the CHT. Lessons learned from this study will be useful in formulating effective policies for community based forest management in Bangladesh and other developing countries.

Complete oral rehabilitation in a case with severe dental fluorosis

The authors have presented a technique of full occlusal rehabilitation in a case of severe dental fluorosis. In this technique, maxillary and mandibular anterior teeth were simultaneously prepared and restored first. This was followed by simultaneous preparation of maxillary and mandibular posterior teeth that were restored in canine guided occlusion. The technique and sequence followed here is unique and is not available in dental literature. This technique reduces number of appointments while fulfilling all objectives. Periodontal followup over 3 years was satisfactory. A restorative treatment protocol has been devised for fluorosis which will act as a guide for the dental practitioners.

Amputation stump management:A narrative review

In this review intended for medical staff involved in patient rehabilitation,we provided an overview of the basic methods for managing amputation stumps.After the amputation surgery,it is imperative to optimize the remaining physical abilities of the amputee through rehabilitation processes,including postoperative rehabilitation,desensitization,and continuous application of soft or rigid dressings for pain reduction and shaping of the stump.Depending on the situation,a prosthesis may be worn in the early stage of recovery or an immediate postoperative prosthesis may be applied to promote stump maturation.Subsequently,to maintain the range of motion of the stump and to prevent deformation,the remaining portion of the limb should be positioned to prevent contracture.Continuous exercises should also be performed to improve muscle strength to ensure that the amputee is able to perform activities of daily living,independently.Additionally,clean wound or edema management of the stump is necessary to prevent problems associated with wearing the prosthesis.Our review is expected to contribute to the establishment of basic protocols that will be useful for stump management from the time of completion of amputation surgery to the fitting of a prosthesis to optimize patient recovery.