Background: Stroke survivors returning home after discharge from hospital and their carers require support to meet their rehabilitation needs (independence in Activities of Daily Living, exercise, psychosocial support...Background: Stroke survivors returning home after discharge from hospital and their carers require support to meet their rehabilitation needs (independence in Activities of Daily Living, exercise, psychosocial support). Voluntary or charitable care providers may be able to address some of these needs. Objective: To explore the feasibility of delivering and evaluating enhanced support to stroke survivors and their carers, with a Rehabilitation Support Worker (RSW). Methods: 16 consecutive stroke survivors and their carers were included. All participants received usual hospital care. Seven of these patients and their carers were also allocated an RSW from a charitable care provider. The RSW accompanied therapy training sessions with the patient, carer and therapist in hospital. On discharge, the RSW visited the patient and carer at home over the initial 6 week post-discharge period to support them in practising rehabilitation skills. Patient function (Barthel Index) and patient/carer confidence were independently assessed at discharge (Week 0). The above assessments and patient/carer mood (GHQ-12) and Carer Giver Strain were also assessed at Weeks 1, 6 and 12. RSWs were interviewed for their views about the service. Results: Participants’ functional ability at Week 1 post-discharge was significantly higher in the RSW group. At 6 and 12 weeks post-discharge, functional ability was not significantly different between groups. Carers in the intervention group were less confident at all time points, however, this was not significant. There was no significant effect on carer strain or well-being. Interviews with RSWs highlighted areas of their training that could be enhanced and the need for greater clarity as to their role. Conclusions: The results showed that a definitive trial of rehabilitation support is feasible. A number of obstacles however would need to be overcome including: difficulty in identifying suitable patients, clarity of the RSW role, and appropriate training content.展开更多
Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome.Co-existence of viral hepatitis and hepatic sarcoidosis is a rare,but recognised phenomenon.Obtaining a balance between imm...Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome.Co-existence of viral hepatitis and hepatic sarcoidosis is a rare,but recognised phenomenon.Obtaining a balance between immune suppression and anti-viral therapy may be problematic.Immunosuppression in the presence of viral hepatitis can lead to rapid deterioration of liver disease.Similarly,anti-viral therapy may exacerbate granulomatous hepatitis.Here we present two cases of viral hepatitis co-existing with sarcoidosis that illustrate successful management strategies.In one,hepatitis B replication was suppressed with oral antiviral therapy before commencing prednisolone.In the second,remission of hepatic sarcoidosis was achieved with prednisolone,before treating hepatitis C and obtaining a sustained virological response with pegylated interferon and ribavirin therapy.展开更多
文摘Background: Stroke survivors returning home after discharge from hospital and their carers require support to meet their rehabilitation needs (independence in Activities of Daily Living, exercise, psychosocial support). Voluntary or charitable care providers may be able to address some of these needs. Objective: To explore the feasibility of delivering and evaluating enhanced support to stroke survivors and their carers, with a Rehabilitation Support Worker (RSW). Methods: 16 consecutive stroke survivors and their carers were included. All participants received usual hospital care. Seven of these patients and their carers were also allocated an RSW from a charitable care provider. The RSW accompanied therapy training sessions with the patient, carer and therapist in hospital. On discharge, the RSW visited the patient and carer at home over the initial 6 week post-discharge period to support them in practising rehabilitation skills. Patient function (Barthel Index) and patient/carer confidence were independently assessed at discharge (Week 0). The above assessments and patient/carer mood (GHQ-12) and Carer Giver Strain were also assessed at Weeks 1, 6 and 12. RSWs were interviewed for their views about the service. Results: Participants’ functional ability at Week 1 post-discharge was significantly higher in the RSW group. At 6 and 12 weeks post-discharge, functional ability was not significantly different between groups. Carers in the intervention group were less confident at all time points, however, this was not significant. There was no significant effect on carer strain or well-being. Interviews with RSWs highlighted areas of their training that could be enhanced and the need for greater clarity as to their role. Conclusions: The results showed that a definitive trial of rehabilitation support is feasible. A number of obstacles however would need to be overcome including: difficulty in identifying suitable patients, clarity of the RSW role, and appropriate training content.
文摘AIM: To assess outcomes after colonic stent insertion for obstructing colorectal malignancies performed by an endoscopist without radiologist support.
文摘Hepatic sarcoidosis is usually asymptomatic but rarely leads to adverse liver-related outcome.Co-existence of viral hepatitis and hepatic sarcoidosis is a rare,but recognised phenomenon.Obtaining a balance between immune suppression and anti-viral therapy may be problematic.Immunosuppression in the presence of viral hepatitis can lead to rapid deterioration of liver disease.Similarly,anti-viral therapy may exacerbate granulomatous hepatitis.Here we present two cases of viral hepatitis co-existing with sarcoidosis that illustrate successful management strategies.In one,hepatitis B replication was suppressed with oral antiviral therapy before commencing prednisolone.In the second,remission of hepatic sarcoidosis was achieved with prednisolone,before treating hepatitis C and obtaining a sustained virological response with pegylated interferon and ribavirin therapy.
