Tracheostomy prevalence at Skilled Nursing Facilities.

The incidence of chronically ill subjects with prolonged mechanical ventilation has significantly increased over the last decade. Many patients get discharge to Skilled Nursing Facilities with an artificial airway, which do not have the means to properly progress on weaning. In Portugal this prevalence is unknown. Our aim was to establish the prevalence of tracheostomized patients at SNF in the North of Portugal, characterizing these units and its population, in a cross-sectional study, through an online questionnaire answered on the same day. Of the 75 SNF, 30 answered: 13 long-term, 2 medium-term, 2 short-term, 12 had beds of both medium and long-term and 1 had the three typologies. 33 had tracheostomy ventilation (prevalence 3.36%), all admitted at long-term units, the majority transferred from previous hospital admission (n=27, 90%). Only one was under mechanical ventilation. The most frequent reason for tracheostomy placement was acute respiratory failure (n=10, 33.3%). The most commonly presented cannula was the fenestrated non-cuffed (n=17, 59%). Only 4 were performing occlusion training, 21 needed frequent secretion suctioning and 1 used the mechanical in-exsufflation. Regarding motor function, 16 (53.3%) were unable to achieve sitting balance and 20 (66.7%) had no orthostatic balance or walking ability. 14 (46.7%) had percutaneous endoscopic gastrostomy. Although low response rate may induce some bias, this study revealed a significant prevalence of tracheostomized patients at SNF. These facilities do not have the resources to safely and effectively progress on ventilatory weaning. It is essential to establish new referral criteria and create specialized weaning units.

Prescripción de ejercicio en pacientes de oncología: principios generales / Exercise prescription in oncology patients: general principles

Objetivo. La incidencia de las enfermedades oncológicas, así como las tasas de supervivencia de los pacientes con cáncer han aumentado en los últimos años. La investigación sobre el cáncer también ha aumentado, particularmente, con respecto a la función del ejercicio. Se realiza una revisión de la literatura sobre la prescripción de ejercicio en los pacientes oncológicos. Materiales y métodos. Se realiza una búsqueda en los libros de referencia y bases de datos electrónicas. Resultados. El ejercicio otorga beneficios a los pacientes oncológicos con respecto a la fatiga y desempeño funcional y físico. Además, el ejercicio muestra efectos prometedores en el mantenimiento de la composición corporal, el metabolismo, el funcionamiento inmune, y el psicológico. Las sociedades internacionales recomiendan 30 min de actividad física aeróbica moderada, por lo menos 5 veces a la semana, entrenamiento de fuerza 3 veces por semana, y ejercicios de flexibilidad. El ejercicio debe ser prescrito en una base individual, teniendo en cuenta la edad, el nivel de actividad anterior, la tolerancia al esfuerzo, el diagnóstico, el estadio de la enfermedad, el enfoque terapéutico, y las comorbilidades de los pacientes. Conclusiones. El ejercicio juega un papel importante como adyuvante del tratamiento oncológico(AU)

Objective. The incidence of oncological diseases as well as the survival rates of cancer patients has risen in recent years. Cancer-related research has also increased, particularly with respect to the role of exercise. We performed a review of the literature on exercise prescription in oncology patients. Materials and methods. A search was conducted in reference textbooks and electronic databases. Results. Exercise bestows benefits to oncology patients with respect to fatigue, functional and physical performance. In addition, exercise exhibits promising effects in the maintenance of the body composition, metabolism, immune and psychological functioning. International Societies recommend 30 min of moderate aerobic physical activity at least five times per week, strength training three times per week, and flexibility exercises. Exercise must be prescribed on an individual basis, taking age, previous activity level, tolerance to exertion, diagnosis, disease stage, therapeutic approach, and the patients’ comorbidities into account. Conclusions. Exercise plays an important role as an adjuvant of oncological treatment(AU)