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Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study / K.J. Haines in Physiotherapy, 2013/2 (2013)
Titre : Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study Type de document : Article Auteurs : K.J. Haines ; E.H. Skinner ; S. Berney Année de publication : 2013 Article en page(s) : pp. 119-125 Langues : Anglais (eng) Descripteurs : HE Vinci
Complications postopératoires ; Kinésithérapie (spécialité) ; Laparotomie
Mots-clés : Postoperative Complications Early Ambulation Lever précoce Physical Therapy Specialty Pneumonia Pneumopathie infectieuse Laparotomy General Surgery Chirurgie générale Résumé : Objectives
Previous Australian studies reported that postoperative pulmonary complications affect 13% of patients undergoing upper abdominal laparotomy. This study measured the incidence of postoperative pulmonary complications, risk factors for the diagnosis of postoperative pulmonary complications and barriers to physiotherapy mobilisation in a cohort of patients undergoing high-risk abdominal surgery.
Prospective, observational cohort study.
Two surgical wards in a tertiary Australian hospital.
Seventy-two patients undergoing high-risk abdominal surgery (participants in a larger trial evaluating a novel model of medical co-management).
Main outcome measures
Incidence of, and risk factors for, postoperative pulmonary complications, barriers to mobilisation and length of stay.
The incidence of postoperative pulmonary complications was 39%. Incision type and time to mobilise away from the bed were independently associated with a diagnosis of postoperative pulmonary complications. Patients were 3.0 (95% confidence interval 1.2 to 8.0) times more likely to develop a postoperative pulmonary complication for each postoperative day they did not mobilise away from the bed. Fifty-two percent of patients had a barrier to mobilisation away from the bed on the first postoperative day, with the most common barrier being hypotension, although cessation criteria were not defined objectively by physiotherapists. Development of a postoperative pulmonary complication increased median hospital length of stay (16 vs 13 days; P = 0.046).
This study demonstrated an association between delayed postoperative mobilisation and postoperative pulmonary complications. Randomised controlled trials are required to test the role of early mobilisation in preventing postoperative pulmonary complications in patients undergoing high-risk upper abdominal surgery.
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in Physiotherapy > 2013/2 (2013) . - pp. 119-125[article]Medical Complications During Inpatient Rehabilitation Among Patients With Traumatic Disorders of Consciousness / John Whyte in Archives of Physical Medicine and Rehabilitation, 2013/10 (2013)
Titre : Medical Complications During Inpatient Rehabilitation Among Patients With Traumatic Disorders of Consciousness Type de document : Article Auteurs : John Whyte ; M Nordenbo Annette ; Kathleen Kalmar ; [et al.] Article en page(s) : pp. 1877-1883 Langues : Anglais (eng) Descripteurs : HE Vinci
Hydrocephalie ; Rééducation et réadaptation
Mots-clés : Autonomic Nervous System Diseases Maladies du système nerveux autonome Brain Injuries Lésions encéphaliques Consciousness Disorders Troubles de la conscience Dyssomnias Dyssomnies Hydrocephalus Muscle Hypertonia Hypertonie musculaire Persistent Vegetative State État végétatif persistant Pneumonia Pneumopathie infectieuse Urinary Tract Infections Infections urinaires Résumé : Objective
To assess the incidence of medical complications in patients with recent traumatic disorders of consciousness (DOCs).
Data on adverse events in a placebo controlled trial of amantadine hydrochloride revealed no group difference, which allowed these events to be reanalyzed descriptively as medical complications experienced by the 2 groups collectively.
Eleven clinical facilities in the United States, Denmark, and Germany with specialty rehabilitation programs for patients with DOCs.
Patients (N=184) with nonpenetrating traumatic brain injury enrolled from acute inpatient rehabilitation programs between 4 and 16 weeks postinjury.
Participants were randomized to receive 200 to 400mg of amantadine hydrochloride or placebo daily for 4 weeks, and followed for an additional 2 weeks. Adverse events were recorded and categorized with respect to their nature, timing, and severity.
Main Outcome Measure
Number, type, and severity of medical complications occurring during the 6-week study interval.
A total of 468 medical complications were documented among the patients (.40 events per week per patient). More than 80% of patients experienced at least 1 medical complication, and 41 of these were defined as serious adverse events. New medical complications declined over time in rehabilitation and were not dependent on time since injury. Hypertonia, agitation/aggression, urinary tract infection, and sleep disturbance were the most commonly reported problems. Hydrocephalus, pneumonia, gastrointestinal problems, and paroxysmal sympathetic hyperactivity were the most likely to be severe.
Patients with DOCs have a high rate of medical complications early after injury. Many of these complications require brain injury expertise for optimal management. Active medical management appears to contribute to the reduction in new complications. An optimal system of care for DOC patients must provide expert medical management in the early weeks after injury.
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in Archives of Physical Medicine and Rehabilitation > 2013/10 (2013) . - pp. 1877-1883[article]Pneumonie en gériatrie / B. De Wazieres in Repères en gériatrie, 116 (MARS 2012)
Titre : Pneumonie en gériatrie Type de document : Article Auteurs : B. De Wazieres ; V. Antoine Article en page(s) : 69-73 pp Langues : Français (fre) Descripteurs : HE Vinci
Gériatrie ; Sujet âgé
Mots-clés : PNEUMOPATHIE INFECTIEUSE Disponible en ligne : Non Permalink :
in Repères en gériatrie > 116 (MARS 2012) . - 69-73 pp[article]
Cote Support Localisation Section Disponibilité REV Périodique papier Woluwe (Promenade de l'Alma) périodiques Consultation sur place uniquement
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