[Preoperative Disability and Its Influencing Factors in Patients With Lumbar Spondylolisthesis].

BACKGROUND: Patients with lumbar spondylolisthesis typically suffer from symptom discomfort and various degrees of disability for months or years prior to receiving surgical treatments. Knowing the factors that influence the disability status of these patients will help healthcare providers develop effective preventive measures. PURPOSE: To explore preoperative disability and its important predictive factors in patients with lumbar spondylolisthesis. METHODS: A predictive correlational design was used and a convenience sample of eighty-six lumbar spondylolisthesis preoperative patients were recruited from a medical center in northern Taiwan. Data were collected using a study questionnaire, which included the Oswestry disability index, the revised geriatric depression scale-short form, and a pain numeric rating scale. RESULTS: The average disability index of the participants was 48.52 (SD = 16.14). The multiple linear regression analyses identified lower back pain, depression, age, and gender as significant predictors of preoperative disability, collectively explaining 40.9% of the variation in disability severity. Being female, being older, having a higher degree of lower back pain, and having depression were significantly associated with preoperative disability. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The results of the present study indicate that lumbar spondylolisthesis patients who are older in age, female, currently experiencing lower back pain, and suffering from depression face a higher risk of preoperative disability. Patients in these at-risk categories should be assessed actively and provided with appropriate patient education in order to enhance their quality of life.

Tanshinone IIA decreases the levels of inflammation induced by Aß1-42 in brain tissues of Alzheimer's disease model rats.

To study the pathogenesis of Alzheimer's disease (AD) and explore the possible anti-inflammatory mechanism of tanshinone IIA (TanIIA), we evaluated the quantity of neurons and the expression levels of interleukin-1ß (IL-1ß), IL-6, glial fibrillary acidic protein, CD11b, C1q, C3c, and C3d in brain tissues of AD rats treated with TanIIA. Thirty male Sprague-Dawley rats were randomized into three groups: sham group, TanIIA treatment group, and Aß1-42 group. Aß1-42 treatment was performed by injecting Aß into the hippocampus of rats and then tagged position. Brain tissue morphological structure has been observed with HE staining and the staining of exogenously injected Aß1-42 was observed by immunohistochemistry, which confirms the success of the Aß1-42 group. After TanIIA treatment, levels of IL-1ß, IL-6, glial fibrillary acidic protein, CD11b, C1q, C3c, and C3d were measured in paraffinized brain tissue sections from all groups by immunohistochemistry staining. The results showed that no 6E10 was detected in the control group, and the difference in the expression levels of 6E10 between the Aß1-42 group and the TanIIA treatment group was not significant (P>0.05), suggesting that both the Aß1-42 group and the TanIIA treatment group received the same amount of Aß. The Aß1-42 group showed a significant increase in the expression levels of inflammatory markers compared with the sham group (P<0.05) and the TanIIA treatment group showed a partial improvement in reducing inflammation. Therefore, Aß triggered brain inflammation and activated the complement system. TanIIA treatment reduced the number of astrocytes and microglial cells, and induced a partial decrease in complement molecules in the brain of AD rats. These findings suggested that TanIIA may represent a potential therapeutic treatment in neurodegenerative diseases such as AD to support the survival of neurons by reducing expression levels of inflammatory factors.

A survey of patients' quality of life and health-care needs prior to undergoing total joint replacement surgery.

The objective of this study was to identify patients' quality of life (QOL) and health-care needs before undergoing total joint replacement surgery. This study used a cross-sectional descriptive survey approach. Data were collected in 2007. The results for role limitations because of physical functioning were the lowest. Health-care needs for exercise guidance were the highest. Male participants experienced superior QOL for the physical components (t = 2.379, P < .05). Participants who were single (F = 3.804; F = 4.539) and employed full time (F = 4.961; F = 3.994) had superior QOL for both the physical and mental components (P < .05). The predictive factors for physical components of QOL included occupational status, the previous total joint replacement and other health problems. The predictive factor for the mental components of QOL was marital status. Because role performance is limited by physical functioning, the participants experienced a poor QOL for the physical components. The participants had substantial health-care needs before surgery, particularly for rehabilitation exercise guidance and pain management.

The effects of a care map for total knee replacement patients.

AIMS: The aim of this study was to establish and evaluate the effectiveness of a care map for total knee replacement patients. BACKGROUND: Bureau of National Health Insurance in Taiwan is about to launch a diagnosis-related group. This major reform has seriously affected the running of medical institutions, which are facing unprecedented management pressure. DESIGN: A quasi-experimental control group design was carried out. METHODS: Eighty-three patients were recruited, with 39 experimental group patients received nursing care based on a care map, while 44 patients who were in control group received routine nursing care. An interdisciplinary team designed the care map, which included items required for patient care from outpatient to postdischarge. RESULTS: (1) The mean age of patients was 72·73 (SD 8·42) years. Mean length of stay was 4·92 (SD 0·77) days for the experimental group and 7·09 (SD = 1·09) for the control group. Difference between groups was significant (t = -10·285, p < 0·001). The medical cost for the experimental group was less than that for the control group (t = -6·03, p < 0·001). (2) The self-care efficacy score before discharge for the experimental group was higher than that for the control group (t = 5·90, p < 0·001). (3) Significant improvements were observed in activities of daily living for both groups with the passage of time after discharge (F = 229·034, p < 0·001), and the experimental group was better than the control group (F = 40·895, p < 0·001). The instrumental activities of daily living abilities of both groups were also significant improvements with the passage of time after discharge (F = 46·568, p < 0·001), and the experimental group was better than the control group (F = 32·163, p < 0·001). CONCLUSIONS: A care map for total knee replacement patient can shorten length of stay, save medical cost and improve patient's functional recovery. RELEVANCE TO CLINICAL PRACTICE: Results of this study can be used as a basis for practical implementation of care map in total knee replacement patients.

Risk factors in cutout of sliding hip screw in intertrochanteric fractures: an evaluation of 937 patients.

The aim of this study was designed to assess the risk factors of lag-screw cutout in the treatment of intertrochanteric fracture with a dynamic hip screw (DHS). From 2003 to 2007, 1,150 patients who had acute unilateral intertrochanteric fractures of the femur were enrolled to the study. All fractures were managed by closed reduction and internal fixation with 135° DHS devices. Patient demographics, fracture patterns, reduction and fixation and perioperative course parameters were all recorded. The follow-up period was 38 months on average (range 16-60 months). Finally, 937 patients were available for evaluation of final results in which we focused on lag-screw cutout. Excluding complications not related to screw position, 64 patients (6.8%) with screw cutout were encountered, and the remaining 873 patients had uneventful union, with the average union time of 17.5 weeks (range15-24 weeks). Upon analysis with logistic regression, the tip-apex distance (TAD) was shown to be the most important predictive factor for cutout, followed by screw position, fracture pattern, reduction and patient age. In order to decrease the risk of lag-screw cutout, it is important to ensure good fracture reduction and to place the lag screw in either the middle/middle or inferior/middle position with appropriate TAD.

To evaluate the effectiveness of a discharge-planning programme for hip fracture patients.

AIMS AND OBJECTIVES: This study aimed to evaluate the effectiveness of a comprehensive discharge-planning service for hip fracture patients, including length of stay, functional status, self-care knowledge and quality of life (QOL). BACKGROUND: Hip fractures are the most devastating result of osteoporosis. Care of these patients from the moment they enter the hospital until discharge and postdischarge is a challenging task, requiring a coordinated approach by an interdisciplinary team. DESIGN: An experimental design was used. Methods. Fifty hip fracture patients were recruited from a medical centre in Taipei, Taiwan and randomly divided into two groups. The control group received routine discharge nursing care and the experimental group received comprehensive discharge planning. After patient admission, researchers assessed discharge-planning needs, provided discharge nursing instruction, coordinated services and determined discharge placement based on assessment results. RESULTS: (i) Mean age of 50 hip fracture patients was 78.75 (SD 6.99) years. Mean length of stay was 6.04 (SD 2.41) days for the experimental group and 6.29 (SD 2.17) for the control group. Difference between groups was not significant (t = -0.394, p = 0.696). (ii) The self-care knowledge of the experimental group was higher than that of the control group (F = 11.569, p = 0.001). (iii) Significant improvements were observed in functional status of both groups at three months postdischarge, with no significant differences observed between groups. However, the functional status of experimental group patients showed a slightly better trend than that of the control group. (iv) At three months postdischarge, QOL of experimental group patients was better than control group patients. CONCLUSIONS: A comprehensive discharge-planning service can improve hip fracture patients' self-care knowledge and QOL. RELEVANCE TO CLINICAL PRACTICE: Results of this study can be used clinically as a basis for practical implementation of discharge-planning services in fracture patients.