Enhancing functional recovery following postpartum femoral neuropathy: early neurorehabilitation and multidisciplinary obstetric care.

Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.

Burnout among Physicians Working in Palliative Care During the COVID-19 Pandemic in Portugal: A Cross-Sectional Study.

INTRODUCTION: Physicians working in palliative care have a greater risk of burnout. Burnout has three dimensions: emotional exhaustion, depersonalization and reduction of personal accomplishments. Burnout is associated with different consequences for the professionals like less professional satisfaction and increase of overall levels of exhaustion. Burnout in healthcare professionals has an impact in the patients with increased probability of clinical erros. In order to monitor the quality of the care it is mandatory to assess overall levels of burnout. This study aimed to determine burnout levels and associated variables of physicians working in the Portuguese national network of palliative care. MATERIAL AND METHODS: A cross-sectional, exploratory and quantitative design was employed and participants were sampled using convenience and snowball technique. The Copenhagen Burnout Inventory was used to determine burnout levels of physicians working in the Portuguese National Network of Palliative Care. The contributions of personal, work and COVID-19 variables were evaluated in three subclasses: work, personal and patient-related burnout. The results obtained enabled the identification of healthcare professionals at risk, comparison with previous results published and to assess the impact of COVID-19 in their non COVID-19 activity. RESULTS: Seventy-five physicians participated. Socio-demographic characterization was conducted and the levels of burnout and determinants were explored. High levels of personal, work and patient-related burnout were present in 32 (43%), 39 (52%) and 16 (21%) physicians, respectively. The majority agreed that COVID-19 had an impact on their activities. Exclusive dedication to palliative care and type of palliative care unit were associated with lower levels of patient and work-related burnout. Weekly physical activity was associated with lower levels of work and personal burnout. Self-perceived health status was associated with lower levels of burnout for all subclasses. CONCLUSION: There was a high level of burnout among physicians working in the Portuguese National Network of Palliative Care. Measures to identify and prevent burnout are necessary in order to protect these professionals.

Introdução: Os médicos que trabalham em cuidados paliativos apresentam um risco mais elevado de burnout. Esta perturbação psicológica carateriza-se por três dimensões ­ exaustão emocional, despersonalização e redução da realização pessoal ­ e está associada a diversas consequências para os profissionais como a diminuição da satisfação profissional ou o aumento dos níveis de exaustão. Ao afetar os profissionais de saúde, o burnout tem também impacto nos utentes, visto causar um aumento da probabilidade de erros clínicos. Com vista a monitorizar a qualidade dos cuidados prestados é fundamental monitorizar os níveis de burnout. O objetivo deste estudo foi o de determinar os níveis de burnout e varíaveis associadas dos médicos que trabalham na Rede Nacional de Cuidados Paliativos em Portugal. Material e Métodos: Estudo transversal, exploratório e quantitativo com amostragem por conveniência e bola de neve. Foi utilizado o questionário Copenhagen Burnout Inventory para determinar os níveis de burnout de médicos que exercem funções na Rede Nacional de Cuidados Paliativos. As contribuições das varíaveis pessoais, laborais e decorrentes da pandemia de COVID-19 foram analisadas segundo três subclasses: burnout pessoal, burnout relacionado com a atividade profissional e burnout relacionado com o utente. Os resultados obtidos permitiram identificar profissionais em risco, fazer uma comparação com resultados prévios na literatura e determinar o impacto da COVID-19 na atividade assistencial não relacionada com COVID-19. Resultados: Setenta e cinco médicos participaram neste estudo. Foi realizada a caraterização socio-demográfica e determinados os níveis de burnout e variáveis associadas. Níveis elevados de burnout pessoal, relacionados com a atividade profissional e para com o utente estavam presentes, respetivamente, em 32 (43%), 39 (52%) e 16 (21%) dos participantes. A maioria considerou que a COVID-19 teve um impacto na sua atividade clínica. A dedicação exclusiva em cuidados paliativos e o tipo de unidade de cuidados paliativos estavam associados a menor nível de burnout relacionado com atividade profissional e para com o utente. A autopercepção de saúde estava associada a menores níveis de burnout em todas as subclasses. Conclusão: Foi observado um elevado nível de burnout nos médicos que trabalham na Rede Nacional de Cuidados Paliativos. São necessárias medidas para identificar e prevenir o burnout nestes profissionais,com vista à sua proteção.

Burnout Determinants among Nurses Working in Palliative Care during the Coronavirus Disease 2019 Pandemic.

Nurses working in palliative care are at risk of burnout. The Copenhagen Burnout Inventory was used to determine burnout levels of nurses working in the Portuguese national network of palliative care. We evaluated the contribution of personal, work, and COVID-19 variables in three burnout subclasses: personal, work, and patient-related. A cross-sectional, exploratory, and quantitative design was employed and participants were sampled using convenience and snowball technique. An online survey was conducted and 153 nurses participated in our study. Socio-demographic characterization was conducted, levels of burnout and determinants were explored through multiple linear regression models for its three dimensions. High levels of personal, working, and patient burnout were present in 71 (46%), 68 (44%), and 33 nurses (22%), respectively. Most of them agreed that COVID-19 had an impact on their activities. Significant personal and work related burnout factors found were specialization in palliative care, self-perceived health status, unit type, weekly hours of work, and allocation to COVID-19 units. Gender was found to be a significant factor in patient-related burnout. There is a high level of burnout among nurses working in the Portuguese national network of palliative care. Measures for identification and mitigation of burnout are necessary to protect health care professionals.

Hip osteoarthritis treatment with intra-articular injections: hyaluronic acid versus glucocorticoid - a systematic review.

OBJECTIVE: To compare the effects of intra-articular injection of glucocorticoid (GC) and hyaluronic acid (HA) on pain and disability caused by hip osteoarthritis (HO). MATERIALS AND METHODS: A systematic review of the literature was carried out within MEDLINE (via PubMed), Web of Science, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) databases, using the keywords (MeSH words): "hip osteoarthritis", "glucocorticoid", "corticosteroid", "corticoid", "hyaluronic acid" and "viscosupplementation". Two independent authors applied inclusion and exclusion criteria, selecting randomized clinical trials with direct comparison between intra-articular injection of GC and HA in patients with HO. RESULTS: 157 articles were found in the initial search. After applying the exclusion criteria, 36 articles were read, with final selection of 3 randomized clinical trials (n = 484). Two studies compared the administration of these products with placebo (saline) - and one also compared it with a fourth group of patients undergoing only physical therapy. Qvistgaard et al. demonstrated clinical superiority of GC (moderate clinical benefit) and HA (marginal clinical benefit) in pain, at 4 weeks, both compared to placebo; however, there was no statistically significant difference between GC and HA during the 12-week follow-up. Atchia et al. reported a statistically significant improvement in pain and function in patients treated with GC during 8 weeks. Spitzer et al. demonstrated an overall clinical response in patients in both groups throughout the study, with a faster response for those treated with GC. However, the authors highlight the superiority in all outcome measures of HA compared to GC in cases of moderate HO, at 26 weeks. DISCUSSION: Few studies directly compare the clinical effect between intra-articular injections of GC and HA in HO, showing heterogeneity in the type of population, number of administrations, formulation of HA and follow-up period. The analyzed studies had a short follow-up time. The results obtained seem to demonstrate a superiority of GC compared to HA in managing pain, namely in the speed of clinical response. However, Spitzer et al. demonstrated an overall superiority of HA in patients with moderate HO, which suggests that optimal selection of patients remains to be defined.