Research on heart disease have found a strong and consistent evidence of association between some psychosocial risk factors, including depression, anxiety, self-efficacy, lack of social support and outcome of disease. Depression increases the risk of cardiac death and is highly predictive of reduced adherence to recommended treatments; anxiety appears to be linked to adverse cardiac outcomes. It was demonstrated that Cardiac Rehabilitation (CR) leads to substantial improvements and positive outcomes because combines the prescription of physical activity with the modification of risk factors and aims to reduce symptoms related to the disease and the risk of new cardiovascular events. The main objective of this study is to determine if a short and intense CR program can produce a positive impact on anxious and depressive symptoms revealed in cardiac patients, confirming results of previous researches. The protocol was proposed to all patients referred for an outpatient CR after an acute event who attended the short 2-week intensive rehabilitation program. A total of 157 patients recruited at the operating unit of Cardiology, in the Hospital of Cittadella (Italy), was included in the analysis. The Beck Depression Inventory-II and the State-Trait Anxiety Inventory-Y were administered to the patients. SPSS 17.0 was used for statistical analysis. T-tests for paired samples were used to evaluate differences between the beginning and the end of the CR program. There was a statistically significant difference between the beginning and the end of the CR program. Results for paired samples showed significant differences in all factors of the BDI-II and in the total score. In addition, a statistically significant difference was found even in the state - anxiety subscale. No significant difference was detected for the trait anxiety. According to recent studies, this research shows that the CR program has a significant impact on levels of anxiety and depression, because all activities focus their commitment on changing the patient's personal beliefs and perception of illness, promoting the exchange of information and sharing of concerns and fears, increasing the patient's resilience with the aim of enabling him/her to reorganize positively his/her personal, family and professional sphere.

AimOptimal treatment and rehabilitation for paediatric soft tissue injury is not widely discussed in literature therefore determining optimal management is based on each individual patient needs. Experimental and clinical studies demonstrate that early, controlled mobilisation is superior to immobilisation for primary treatment of acute musculoskeletal soft-tissue injuries and postoperative management. Children with soft tissue injury presenting at the emergency department are routinely referred to Physiotherapy. Referrals are screened to establish their Physiotherapy needs and families were called to appoint. This was a timely process therefore a decision was made to redesign our service. Method All children who attended emergency department with a soft tissue injury were issued with a Physiotherapy Opt In letter to enable families to contact our department within a 48 hour period for an urgent physiotherapy appointment. A pathway was developed to access Physiotherapy service for in and out of hours. Education was provided to all minor injury staff on accessing our service and the management of the acute soft tissue injury. An audit was carried on the uptake over a 5 month period.ResultThe audit revealed 36%–55% uptake of referrals that were opting in to Physiotherapy following a visit to the emergency department with a soft tissue injury. Numbers of referrals varied significantly month to month from 17- 48 in one month. Most referrals were received from the weekend and out of hours. As a result of this we set up daily emergency return clinics to cope with service demand.ConclusionTo date we do not know if these numbers replicate our previous way of working on an ‘ad hoc’ basis which is a limitation to the audit. However, of those patients who have not contacted for Physiotherapy appointment, they have not represented with musculoskeletal symptoms later due to the change to our service or deterioration of their symptoms. Staff felt their time was better managed to allocate to other duties and patients. A satisfaction survey to parents may be a way to evaluate its ease of use. This service change has shown benefit to both staff and patient to allow timely management of the soft tissue injury and preventing chronic symptoms.