ABSTRACT
Taking care of patients in complex situation is a challenge as well in outpatient clinics as in hospital settings. Patient complexity varies over time and according to the place of treatment, requiring multiple actors, and usual guidelines are rarely applicable. As multiple organ systems are involved and the need for a "tailored" approach, these patients are often hospitalized in general internal medicine wards. At the CHUV, the internal medicine intermediate care unit is regularly confronted to complex patient situations, for which the health system is not always prepared, thus generating frustrations. The development of improved interprofessional collaboration, through regular exchanges and weekly meetings, has improved care plans and team satisfaction.
La prise en charge des patients en situation complexe est un défi tant en ambulatoire qu'à l'hôpital. La complexité d'un patient varie dans le temps et selon le lieu de prise en charge, nécessitant des intervenants multiples, avec des guidelines rarement applicables. De par leur atteinte multisystémique et le besoin d'une approche « sur-mesure ¼, ces patients sont souvent hospitalisés dans des services de médecine interne. L'Unité des soins intermédiaires de médecine du CHUV est régulièrement confrontée à des situations complexes, face auxquelles le système de santé n'est pas toujours armé, générant des frustrations. Le développement du travail en réseau interprofessionnel au sein de l'équipe, à travers des points de discussion réguliers et un colloque hebdomadaire, a permis d'améliorer ces prises en charge et la satisfaction des équipes.
Subject(s)
Cooperative Behavior , Interprofessional Relations , Humans , Patient Care Team , Internal Medicine , HospitalizationABSTRACT
Although physical activity is recommended in patients on maintenance hemodialysis (MHD), randomized controlled trials testing the effects of exercise in this population have given conflicting results. In general, aerobic exercises mostly failed to produce improvements in physical function, whereas resistance exercises, although less studied, appeared to be more promising. The use of sophisticated materials such as leg press and free weights may preclude widespread application of resistance training in patients on MHD. Simple and cheap elastic bands may thus be an attractive alternative. We tested the feasibility of a supervised intradialytic resistance band exercise training program, and its effects on physical function, in patients on MHD. A total of 11 unselected adult patients on MHD from our center, aged 70 ± 10.7 (mean ± standard deviation) years, including 8 men and 3 women, accepted to follow the program under the supervision of qualified physiotherapists. Thirty-six exercise sessions of moderate intensity (twice a week, mean duration 40 minutes each, during 4.5 to 6 months), mainly involving leg muscles against an elastic resistance, were performed. The exercise program was well tolerated and all patients completed it. Statistically significant improvements were observed in the following tests: Tinetti test, 23.9 ± 3.9 points before versus 25.7 ± 3.5 points after the program (P = .022); the Timed Up and Go test, 12.1 ± 6.6 versus 10 ± 5.8 seconds (P = .0156). Improvements in the 6-minute walk distance and in the one-leg balance tests just failed to reach statistical significance. In this single-center pilot study, an intradialytic resistance band exercise program was feasible, well tolerated, and showed encouraging results on physical function.
Subject(s)
Kidney Failure, Chronic/therapy , Physical Fitness , Renal Dialysis , Resistance Training/methods , Aged , Aged, 80 and over , Exercise , Feasibility Studies , Female , Humans , Male , Middle Aged , Motor Activity , Pilot Projects , Treatment Outcome , WalkingABSTRACT
A venous ulcer is the end result of a long pathological process where venous hypertension represents the principal cause of a number of complications. The physiotherapist by adapting various different therapeutic approaches improves the vascular, joint and respiratory problems of these patients.
