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Patients consistently rate cancer-related fatigue (CrF) as the most prevalent and debilitating symptom. CrF is an important but often neglected patient concern, partly due to barriers to implementing evidence-based interventions. This study explored what an ideal intervention for CrF would look like from the perspectives of different stakeholders and the barriers to its implementation. Three participant populations were recruited: healthcare providers (HCPs; n = 32), community support providers (CSPs; n = 14), and cancer patients (n = 16). Data were collected via nine focus groups and four semi-structured interviews. Data were coded into themes using content analysis. Two main themes emerged around addressing CrF: "It takes a village" and "This will not be easy". Participants discussed an intervention for CrF could be anywhere, offered by anyone and everyone, and provided early and frequently throughout the cancer experience and could include peer support, psychoeducation, physical activity, mind–body interventions, and interdisciplinary care. Patients, HCPs, and CSPs described several potential barriers to implementation, including patient barriers (i.e., patient variability, accessibility, online literacy, and overload of information) and systems barriers (i.e., costs, lack of HCP knowledge, system insufficiency, and time). As CrF is a common post-treatment symptom, it is imperative to offer patients adequate support to manage CrF. This study lays the groundwork for the implementation of a patient-centered intervention for CrF in Canada and possibly elsewhere. [ABSTRACT FROM AUTHOR]

It may be difficult to diagnose cholecystitis just by examining the patient and taking some blood tests. Diagnostic imaging scans may be necessary, as documented by researchers who analyzed the medical literature. Cholecystitis is an inflammation of the gallbladder.

Background: Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke‐specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools. Objective: To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke‐specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items. Design Prospective cohort study. Setting: Inpatient tertiary stroke rehabilitation unit. Participants: Patients (N = 220) with acute stroke. Main Outcome Measures: Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC‐ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non‐fallers using t‐tests. Results: Forty‐eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non‐fallers (P =.001 vs P =.24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi‐neglect between fallers and non‐fallers (P =.03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC‐ROC was 0.65 for SAFR and 0.56 for Morse. Conclusions: SAFR was significantly associated with fall risk and had better discrimination between fallers and non‐fallers than Morse. The neurologic‐specific hemi‐neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed. [ABSTRACT FROM AUTHOR]

Introduction: Implementation of the Canadian Stroke Best Practice Recommendations has improved inpatient rehabilitation. As attention is turned to the design and allocation of rehabilitation after hospitalization, examination of their implications for post-discharge rehabilitation could help optimize service planning Methods: Critical discourse analysis modeled on Alvesson and Sandberg's method of problematization was conducted to determine how the Canadian Stroke Best Practice Recommendations envision and shape post-discharge rehabilitation, and identify any tensions and potential ways to resolve them. Results: Within the Canadian Stroke Best Practice Recommendations post-discharge rehabilitation is implicitly viewed as a continuation of inpatient rehabilitation. Rehabilitation is largely envisioned as a set of biomedical procedures aimed at normalization through correction of impairment. There is potential tension between this implicit goal and the explicit goal of providing patient and family-centered care and promoting reengagement in valued activities and roles. Conclusion: An alternate vision of post-discharge rehabilitation could help resolve this tension. Post-discharge rehabilitation could be envisioned as a self-management intervention. Rather than primarily an expert-driven process of measuring impairment and applying procedures aimed at normalization, rehabilitation would be considered facilitation of self-management with the goal of reengaging in forms of participation that comprise a satisfying life. Implicit assumptions within best practice guidelines powerfully influence recommendations. These ideas are difficult to examine because they seem self-evident. Implicit assumptions in the Canadian Stroke Best Practice Guidelines envision post-discharge stroke rehabilitation as an expert-driven, impairment-focused biomedical procedure. This biomedical image makes it difficult to provide care that meets the guideline's explicit goals of client- and family-centeredness. Reimagining post-discharge stroke rehabilitation as a chronic self-care management intervention aimed at developing a satisfying life after stroke could improve patient care. [ABSTRACT FROM AUTHOR]

Background: Falls in the inpatient stroke population are common, resulting in increased morbidity and slow rehabilitation progress. Falls may result from stroke-specific neurologic deficits; however, assessment of these deficits is lacking in many fall screening tools., Objective: To compare the ability to predict falls of the Stroke Assessment of Fall Risk (SAFR) tool, which includes items related to stroke-specific neurologic deficits, and the commonly used Morse Fall Scale, which does not include these items., Design: Prospective cohort study., Setting: Inpatient tertiary stroke rehabilitation unit., Participants: Patients (N = 220) with acute stroke., Main Outcome Measures: Falls were captured by the medical records from January 2017 to September 2018. Logistic regression analysis evaluated both screening tools for predicting falls by calculating sensitivity, specificity, area under the receiver operating characteristic (AUC-ROC) curve, and odds ratio (OR). We compared SAFR and Morse mean scores between fallers and non-fallers using t-tests., Results: Forty-eight (21.8%) patients experienced ≥1 fall. SAFR, but not Morse, scores showed a statistically significant difference between fallers and non-fallers (P = .001 vs P = .24, respectively). Higher SAFR score was associated with higher odds of falls (OR 1.36, 95% CI [1.12, 1.64]), whereas Morse was not (OR 1.04, 95% CI [0.97, 1.12]). SAFR showed a statistically significant difference in hemi-neglect between fallers and non-fallers (P = .03). Sensitivity and specificity of SAFR were 47.9% and 76.7%, vs 45.8% and 68.0% for Morse, respectively. SAFR positive predictive value and negative predictive value were 36.5% and 84.1%, respectively, similar to Morse (28.6% and 81.8%). The AUC-ROC was 0.65 for SAFR and 0.56 for Morse., Conclusions: SAFR was significantly associated with fall risk and had better discrimination between fallers and non-fallers than Morse. The neurologic-specific hemi-neglect component of SAFR, a component not present on the Morse, was a fall risk factor. Further research evaluating the predictive value of fall scales that include neurologic deficits is needed., (© 2020 American Academy of Physical Medicine and Rehabilitation.)