Effectiveness of a multicomponent rehabilitation protocol on outcomes following post-acute care.

BACKGROUND: The purpose of this study was to determine the effect of a multicomponent rehabilitation protocol on functional outcomes in a post-acute care facility. METHODS: Eleven older, medically complex patients (80.3 ± 7.3 yrs) completed a multicomponent rehabilitation protocol during a stay at a post-acute care facility. Gait speed, Berg Balance scores, and sit-to-stand velocity were examined upon admission and discharge. Bayesian paired sample t-tests were used to determine changes from PRE to POST and linear regression analyses were used to determine the influence of length of stay. FINDINGS: Gait speed increased by 0.26 m/s (49% increase) from PRE (0.65 ± 0.38 m/s) to POST (0.90 ± 0.42 m/s) exercise intervention (p = 0.013). Berg Balance Scores significantly increased by 26% from PRE (38.27 ± 8.33) to POST (45.73 ± 3.32) exercise intervention (p = 0.009). A 45% increase in STS velocity from PRE (0.37 ± 0.14 m/s) to POST (0.51 ± 0.13 m/s; p ≤ 0.001) was observed following the multicomponent rehabilitation protocol. Length of stay did not influence improvements in gait speed, Berg Balance Scores, nor Sit-to-stand velocity (p = 0.176-0.811). INTERPRETATIONS: The multicomponent rehabilitation protocol with movement velocity biofeedback is feasible in a post-acute care facility in medically complex older patients and demonstrates improvements in clinical mobility and balance outcomes.

Thymic adenocarcinoma presenting as an incidental mediastinal mass.

BACKGROUND: Primary thymic adenocarcinoma represents an exceptionally rare malignancy, for which the cornerstone of therapy is margin-negative resection, with radiation and systemic therapy reserved for invasive and advanced disease. Thymic adenocarcinoma has not been previously reported in the setting of a concomitant malignancy, as reported herein. CASE PRESENTATION: We present a case of a 55-year-old previously healthy male diagnosed with acute myeloid leukemia, also found to have a mediastinal mass. Evaluation of the mediastinal mass with tumor markers, biopsies, and next-generation sequencing proved non-diagnostic, while he was simultaneously treated with induction chemotherapy to prevent leukemia-related blast crisis. After completing and recovering from induction chemotherapy, he underwent successful thymectomy during a chemotherapy holiday, with a margin-negative resection of thymic adenocarcinoma. He has subsequently recovered and undergone successful allogeneic hematopoietic stem cell transplant. CONCLUSIONS: We present a case of synchronous adult acute myeloid leukemia and primary thymic adenocarcinoma requiring a tailored approach for management of simultaneous malignancies.

From Cancer Patient to Provider: An Autobiographical Case Report.

Testicular cancer is considered to be the model for the curable neoplasm, with outcomes improving from nearly universal fatality to nearly universal cure in the matter of two decades, driven largely in part by the accidental discovery and application of platinum chemotherapy. Such a diagnosis and treatment can have significant and long-lasting effects on patients, although with every such experience come learning opportunities. This autobiographical case report describes the author's experience being diagnosed with testicular cancer, the challenges faced during treatment and survivorship, the lessons learned being a patient, and the way they guided him on his path to his current role as an adolescent and young adult (AYA) oncologist.

Colorectal Cancer in a Patient With Multiple Myeloma: A Treatment Dilemma.

Multiple myeloma (MM) is a malignancy of plasma cells characterized by the clonal proliferation of plasma cells that produce monoclonal immunoglobulins. While typically considered to be incurable, advances in treatment options have led to remarkable improvements in survival for these patients. Accumulating evidence suggests an increased risk for the development of a secondary primary malignancy (SPM) in these patients, perhaps as a result of myeloma directed therapy or as an effect of their underlying disease process. Here we present a case of a patient who was diagnosed with an SPM while undergoing palliative treatment for multiple myeloma and a treatment approach.

Managing postoperative pain with opioid-sparing therapies.

ABSTRACT: The analgesic properties of opioids make them valuable pharmacologic options for patients with severe post-op pain, but healthcare providers must be cautious due to opioid-related adverse reactions. This article reviews select nonopioid adjuvant and adjunctive medications, as well as select nonpharmacologic therapies, as part of a multimodal approach to postoperative analgesia. The role of nurses in assessing, monitoring, and educating patients is also explored.