Jay Lee

Inpatient Rehabilitation Performance of Patients With Paraneoplastic Cerebellar Degeneration

OBJECTIVE To evaluate the functional improvement of rehabilitation inpatients with paraneoplastic cerebellar degeneration. DESIGN Retrospective review. SETTING Referral-based hospitals. PARTICIPANTS Cancer rehabilitation inpatients (N=7) admitted to 3 different cancer centers with a diagnosis of paraneoplastic cerebellar degeneration. INTERVENTION Medical records were retrospectively analyzed for demographic, laboratory, medical, and functional data. MAIN OUTCOME MEASURE FIM. RESULTS All 7 patients were white women (median age, 62y). Primary cancers included ovarian carcinoma (n=2), small cell lung cancer (n=2), uterine carcinoma (n=2), and invasive ductal breast carcinoma (n=1). Mean admission total FIM score was 61±23.97. Mean discharge total FIM score was 73.6±29.35. The mean change in total FIM score was 12.6 (P=.0018). The mean length of rehabilitation stay was 17.1 days. The mean total FIM efficiency was .73. Of the 7 patients, 5 (71%) were discharged home, 1 (14%) was discharged to a nursing home, and 1 (14%) was transferred to the primary acute care service. CONCLUSIONS To our knowledge, this is the first study to demonstrate the functional performance of a group of rehabilitation inpatients with paraneoplastic cerebellar degeneration. Despite the poor neurologic prognosis associated with this syndrome, these patients made significant functional improvements in inpatient rehabilitation. When appropriate, inpatient rehabilitation should be considered. Further studies with larger sample sizes are needed.

Return to primary service among bone marrow transplant rehabilitation inpatients: An index for predicting outcomes

OBJECTIVE To assess rehabilitation inpatient risk of return to primary (RTP) service in patients with bone marrow transplant (BMT). DESIGN Retrospective review. SETTING Inpatient rehabilitation unit within a tertiary referral-based cancer center. PARTICIPANTS All patients with BMT (131) who were admitted a total of 147 times to inpatient rehabilitation between January 1, 2002, and April 30, 2010. INTERVENTIONS None. MAIN OUTCOME MEASURES We analyzed RTP service and demographic information, cancer characteristics, medications, hospital admission characteristics, and laboratory values. RESULTS A total of 61 (41%) of 147 of BMT admissions were transferred from the inpatient rehabilitation unit back to the primary service. Of those transferred back, 23 (38%) of 61 died after being transferred back to the primary service. Significant or near-significant relationships were found for a platelet count of <43,000 per microliter (P<.01); a creatinine level of >0.9 milligrams/deciliter (P<.01); the presence of an antiviral agent (P=.0501); the presence of an antibacterial agent (P=.0519); the presence of an antifungal agent (P<.05); and leukemia, lymphoma, or multiple myeloma diagnosis (P<.05). Using 5 of these factors, the RTP-BMT index was formulated to determine the likelihood of return to the primary team. CONCLUSIONS Patients with BMT have a high rate of transfer from the inpatient rehabilitation unit back to the primary service. The RTP-BMT index score can be a useful tool to help clinicians predict the likelihood of return to the primary acute care service.

Hispanic Maternal and Children's Perceptions of Neighborhood Safety Related to Walking and Cycling

This study examined neighborhood safety as perceived by children (mean age=10 years) and their mothers, and its association with childrens physical activity. For all eight safety items examined, children perceived their environment as less dangerous than mothers (p<0.05). None of the multiple regression models predicting childrens physical activity by safety perceptions were significant (p>0.10). The maternal perception model explained the highest percentage of variance (R(2)=0.26), compared to the childrens perception model (R(2)=0.22). Findings suggest that future studies should explore relations between self-reported and objectively measured safety barriers to Hispanic youth walking and cycling.

Frequency and reasons for return to acute care in patients with leukemia undergoing inpatient rehabilitation: a preliminary report.

ObjectiveThe aim of this study was to assess the frequency and reasons for return to the primary acute care service among patients with leukemia undergoing inpatient rehabilitation. DesignThis is a retrospective study of all patients with leukemia, myelodysplastic syndrome, aplastic anemia, or myelofibrosis admitted to inpatient rehabilitation at a tertiary referral-based cancer center between January 1, 2005, and April 10, 2012. Items analyzed from patient records included return to the primary acute care service with demographic information, leukemia characteristics, medications, hospital admission characteristics, and laboratory values. ResultsTwo hundred twenty-five patients were admitted a total of 255 times. Ninety-three (37%) of the 255 leukemia inpatient rehabilitation admissions returned to the primary acute care service. Eighteen (19%) and 42 (45%) of the 93 patients died in the hospital and were discharged home, respectively. Statistically significant factors (P < 0.05) associated with return to the primary acute care service include peripheral blast percentage and the presence of an antifungal agent on the day of the inpatient rehabilitation transfer. Using additional two factors (platelet count and the presence of an antiviral agent, both P < 0.11), the Return to Primary–Leukemia Index was formulated. ConclusionsPatients with leukemia with the presence of circulating peripheral blasts and/or an antifungal agent may be at increased risk for return to the primary acute care service. The Return to Primary–Leukemia Index should be tested in prospective studies to determine its usefulness.

Frequency and Reasons for Return to the Primary Acute Care Service Among Patients With Lymphoma Undergoing Inpatient Rehabilitation

To assess the frequency and risk factors for return to the primary acute care service among patients with lymphoma undergoing inpatient rehabilitation.

Comparing High and Low Acculturated Mothers and Physical Activity in Hispanic Children

BACKGROUND Parents represent a key ecological component in influencing their childs physical activity. The aim of this exploratory study was to assess the relationship between maternal acculturation and physical activity in Hispanic children. METHODS 102 Hispanic mothers (mean age 36.2 yrs; +SD 7.3 yrs) and their children (mean age 10.0 yrs, +SD 0.8 yrs) participated. Most of the mothers (74%) were foreign-born, with 62% classified as low acculturated and 38% high acculturated. Demographic, acculturation, and anthropometric measures were completed by mothers and children. Physical activity was measured using accelerometers. Relationships between maternal acculturation and demographic variables and childrens physical activity were examined using chi-square, Analysis of Variance, and simple regression. RESULTS Children had higher physical activity levels than their mothers (t(49) = -7.87, P < .0001). Significant correlations between maternal and childs physical activity levels were observed in moderate (r2 = 0.13, P = .001), vigorous (r2 = 0.08, P = .05), and moderate-to-vigorous physical activity (r2 = 0.17, P = .002). Low acculturated mothers were more likely to have active children compared with high acculturated mothers. Maternal BMI and other demographic characteristics were not significantly associated with childs physical activity. CONCLUSIONS Findings from this study revealed an association among maternal acculturation, role modeling, and childs physical activity.

Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit

Pancytopenia, immunosuppression, and other factors may place patients with multiple myeloma at risk for medical complications. These patients often require inpatient rehabilitation. No previous studies have looked at risk factors for return to the primary acute care service of this patient population.

Opportunities for Adolescent Tobacco Cessation: Developmental and Ecological Perspectives

Several distinctive factors support the argument for developmentally appropriate youth tobacco cessation programs, including the science of adolescents’ evolving brains, as well as the incidence and risks of adolescent tobacco use, and its endemic nature in adolescent milieus and culture. This paper utilizes these factors and insights from the Youth Tobacco Awareness Program (YTAP), a cognitive-behavioral adolescent tobacco cessation program, to support 5 opportunities for developmentally and ecological-based tobacco cessation programs for youth. These opportunities include the continuing need for tobacco cessation, adolescents’ desire to quit tobacco, the need for effective youth tobacco cessation strategies amid broader-based community efforts, and the support of scientific research for program effectiveness. In our experience, the conundrum of youth tobacco use has presented these opportunities for debate, research, and development of enhanced, appropriate, and more effective models of cessation delivery.