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Background: Focused extracorporeal shock wave therapy (ESWT) has been successfully used to treat musculoskeletal conditions, but ESWT stimulates nociceptors, causing pain deep in the tissue during treatment. The occurrence of pain during ESWT is a side effect, but it can help identify painful sites and assess minimum (MiTI) and maximum (MaTI) pain thresholds to ESWT pressure stimuli. This topic has received limited attention in literature. Methods: This observational study describes a specific approach to using ESWT to study pain in 71 patients. The approach proposes moving the ESWT transducer head of the device over the entire joint surface, progressively increasing the energy level until the patient experiences pain. Results: In the study, MiTI and MaTI were 0.218 ± 0.090 and 0.416 ± 0.165 mJ/mm2 in the affected joint and 0.282 ± 0.128 and 0.501 ± 0.174 mJ/mm2 in the contralateral homologous healthy joint, being significantly lower in the affected joint (MiTI: p < 0.001 and MaTI: p = 0.003, respectively). ESWT induced pain in 94.37% of the sites with the highest subjective pain and in a greater number of sites (204) than digital pressure (123) (p < 0.001). All sites with digital pressure pain also had ESWT pain. Conclusions: These results suggest that the ESWT device may be useful in investigating pain in musculoskeletal conditions and tailoring therapy. [ABSTRACT FROM AUTHOR]

Active wearable devices such as protective smart belts have been proposed to reduce hip impact in the event of a fall. This study primarily evaluated the feasibility and acceptance of a specific protective belt among selected patients identified as being at risk of falling who were admitted to an ICS Maugeri Neurorehabilitation Unit from September 2022 to April 2023. According to previous institutional observations, the device was worn between the 6th and 21st days of recovery. Out of 435 admitted patients, 118 were considered eligible, but 101 declined to participate (about 50% refused to wear the belt without first trying it on; the other 50% found it too heavy or difficult to manage). Among the 17 patients who accepted (users), 9 used the belt correctly. The remaining eight patients refused to wear it after 24 h, due to discomfort. Out of 435 patients admitted, we observed at least one fall in 49 patients, of whom 5 were eligible patients; 1 was a user who had quickly refused to use the belt and fell with mild damage. Two non-eligible patients and one eligible non-user patient experienced falls resulting in hip fractures; only in the latter case could the use of the belt have limited the damage to the hip. Difficulties in recruiting patients and low acceptance of the proposed intervention present further challenges. [ABSTRACT FROM AUTHOR]

Abstract Background Evidences on how in-hospital COPD patients are cared in a Rehabilitative Respiratory Unit during the last time before death are lacking. This observational study was aimed at 1. analyzing the characteristics of respiratory patients who die in a Rehabilitative Unit dedicated to advanced care; 2. studying the available organizational support related to the dying process and quality of care in the last week of life. Methods Medical records (MR) of patients suffering from respiratory disease admitted to a Rehabilitative Respiratory Unit during the last seven years (2005–2011) were collected retrospectively. Only MR of patients who died of respiratory complications were considered. This study describes clinical and demographic variables or information about drugs, procedures, health and unprofessional teams, intervention and interaction, habits and wishes in the last week of life. Results 110 patients out of 2,615 subjects (4.2%) died during the period of observation. 87 out of 110 patients fulfilled the inclusion criteria. They were aged, males, retired, severely compromised, with previous stays in an acute hospital and with a long stay in our unit. Most of them were married, lived in a small village and were cared at home by a caregiver. One third of patients came from Intensive Care Units. During the last week of life, hours spent under mechanical ventilation were extremely high both for patients under invasive (22.3 ± 3.1 hours) and non invasive ventilation (NIV) (17.5 ± 3.4 hours). The number of patients who maintained NIV was twice that of the intubated ones. Breathlessness and secretion encumbrance were the main symptoms. Secretion management was necessary in more than 50% of the cases. Communication between patient and doctor was good in the majority (67%) of the cases. Patient’s and family wishes, aimed at improving their relationships, were obtained in a high percentage (63%) of the cases. Doctors prescribed sedative in a half of patients and morphine only in 40% of the cases. Patients mainly died for acute respiratory failure (55%) or infective complications (34%), almost all under mechanical ventilation. Only a minority of them (28%) reported to have had a discussion about end-of-life care with their physician; palliative/end of life decisions were taken in 13% of the cases. Sustaining figures such as psychologist (17%) or clergy (13%) were marginally required. Conclusions The current data have confirmed that, also in a Rehabilitative Respiratory setting, quality of end-of-life care and patient-physician communication need further improvement.

BACKGROUND: The objective of this work was to evaluate the time course of clinical and health-related quality of life outcomes of long-stay ICU survivors' and caregivers' burden. METHODS: The study included 23 subjects of mixed diagnosis (66 ± 11 y, body mass index 26.5 ± 5.6 kg/m²) with a recent episode of acute respiratory failure needing in-hospital rehabilitation. Subjects and caregivers were evaluated at hospital discharge (TO, n = 23) and 6 months later (T6, n = 16). At TO and T6, subjects' clinical status (Dependence Nursing Scale), FVC (percent-of-predicted FVC and percent-of-predicted FEV), maximum inspiratory/expiratory pressures, effort tolerance (sit-to-stand, Takahashi test, 6-min walking distance), and disability (Barthel index) were evaluated. EuroQol-5D (EQ-5D), McGill Quality of Life, General Perceived Self-Efficacy Scale, and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) were assessed. Caregivers' burden was measured by the Family Strain Questionnaire short form and Caregiver Needs Assessment. Correlation between subjects' clinical status and caregiver assessments was performed at TO. RESULTS: At TO, subjects showed compromised EQ-5Dindex (0.42 ± 0.28); 69% of caregivers had high Family Strain Questionnaire and moderate Caregiver Needs Assessment scores (30 ± 13). EQ-5Dindex was significantly related to Dependence Nursing Scale score (P < .001), percent-of-predicted FVC (P < .02), effort tolerance (all P < .01), disability (P < .001), and caregiver Family Strain Questionnaire score (P < .02). At T6, subjects significantly improved percent-of-predicted FVC (P < .05), maximum expiratory pressure (P < .01), effort tolerance (all P < .05), disability (P < .02), and EQ-5Dindex (P < .05), whereas caregivers' burden scores were unchanged. However, the percentage of caregivers with strain increased. CONCLUSIONS: In proIonged-ICU-stay survivors, EQ-5Dindex at hospital discharge is related to clinical status and caregivers' strain. Subjects' clinical status and EQ-5Dindex improves over time, but caregivers' burden remains high, suggesting the need to monitor/support caregivers. [ABSTRACT FROM AUTHOR]

Objectives: During cardiac failure several ontogenically developed adaptional mechanisms are activated. Among these, heat-shock proteins (HSP) are expressed in response to stress. The aim of the present study was to investigate the HSP72 protein expression in lungs, liver, cardiac and skeletal muscles during congestive heart failure (CHF). Methods: CHF was induced in Sprague-Dawley rats by a single intraperitoneal injection of monocrotaline (50 mg/kg). Two groups of animals emerged: a CHF group (n = 10) with right ventricular hypertrophy, pleural and peritoneal effusions, and an Hypertrophy group (n = 12) with right ventricular hypertrophy without CHF. The data for each group were compared with those of control (saline infused) age-matched rats. Lungs, liver, right and left ventricles, soleus, extensor digitorum longus and tibialis anterior muscles were excised and analyzed for HSP72 concentration by Western blot analysis using a specific monoclonal antibody. Noradrenaline levels in the heart were also measured using HPLC. Results: The CHF group showed: (1) reduced right (0.460 ±0.090 vs 0.830 ±0.070 nmol/ventricle, P < 0.01) and left (1.10 ± 0.09 vs 2.10 ± 0.130 nmol/ventricle, P < 0.001) ventricular content of noradrenaline compared to the control; (2) significant activation of HSP72 concentration in right and left ventricles (39.4 ± 1.6 vs 5 ± 0.9% and 13 ± 1.2 vs 3.5 ± 0.6%, P < 0.001 both) and in the liver (39.8 ± 11 vs 6 ± 2%, P < 0.001); (3) no modification in HSP72 concentration in lungs and all of the peripheral muscles considered. The Hypertrophy group showed: (1) unchanged total noradrenaline tissue content as compared to the control; and (2) unmodified HSP72 concentration in all tissues analyzed. Conclusions: The present study demonstrates that CHF, but not compensatory hypertrophy, is a specific stimulus for chronic HSP72 induction in the heart and liver. On the contrary, CHF does not affect HSP in lungs and peripheral muscles. HSP 72 induction represents an intracellular marker of stress reaction which can persist chronically. [ABSTRACT FROM PUBLISHER]