scholarly journals Delivering Telerehabilitation to COVID-19 Inpatients:A Retrospective Chart Review Suggests It Is a Viable Option

2020 ◽  
Vol 16 (S1) ◽  
pp. 64-70
Author(s):  
Kelsey Rosen ◽  
Monika Patel ◽  
Cecelia Lawrence ◽  
Brianne Mooney
Keyword(s):  
Physical Therapy ◽  
Chart Review ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Inpatient Rehabilitation ◽  
Supplemental Oxygen ◽  
Hospitalized Patients ◽  
Home Exercise ◽  
Viable Option ◽  
Therapeutic Exercises

Abstract Background Guidelines for physical therapy management of patients hospitalized with COVID-19 recommend limiting physical therapists’ contact with patients when possible. Telehealth has been viewed as “electronic personal protective equipment” during the COVID-19 pandemic; although telerehabilitation has been shown to be effective with outpatients, it is unknown whether it is a viable option for hospitalized patients. Purpose Our facility developed an algorithm for the use of a physical therapy telerehabilitation program for inpatients with COVID-19. We sought to investigate the safety and viability of the program. Methods We conducted a retrospective chart review of patients admitted with a diagnosis of COVID-19 who received either telerehabilitation only or a combination of telerehabilitation and in-person rehabilitation. Based on the algorithm, COVID-19 inpatients were selected to receive telerehabilitation if they could ambulate independently, could use technology, had stable vital signs, required minimal supplemental oxygen, and were cognitively intact. We analyzed data of inpatients who received telerehabilitation only, which included patient education, therapeutic exercises, and breathing techniques. Results Of 33 COVID-19 inpatients who received telerehabilitation, in-person rehabilitation, or a combination of the two, 12 patients received telerehabilitation only (age range, 33 to 65 years; all but one male). They demonstrated independence with their individualized home exercise programs in one to two sessions, did not require an in-person rehabilitation consultation, did not require increased oxygen, experienced no exacerbation of symptoms, and were discharged home. Conclusions Inpatient telerehabilitation appears to be a viable option for selected hospitalized patients with COVID-19 and may be a safe way of delivering inpatient rehabilitation to isolated or at-risk populations. At our hospital, the use of inpatient telerehabilitation reduced staff exposure while providing important education and services to patients. To our knowledge, no studies have investigated the use of telerehabilitation for hospitalized patients, including those with COVID-19. Our findings suggest that this innovative approach warrants further study.

Increasing Home Health Face-to-Face Certification: Impact of a Hospital-Based Intervention

2018 ◽  
Vol 30 (3) ◽  
pp. 110-115
Author(s):  
Kimberly Pelland ◽  
Emily Cooper ◽  
Alyssa DaCunha ◽  
Kathleen Calandra ◽  
Rebekah Gardner
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Home Health ◽  
Hospitalized Patients ◽  
Post Intervention ◽  
Face To Face ◽  
Hospital Physicians ◽  
Health Agencies ◽  
Community Physician ◽  
Home Health Agencies

Medicare requires that home health patients have a face-to-face visit with a physician when services are initiated and that physicians provide certification of this encounter before home health agencies (HHAs) can be reimbursed. We assessed an intervention to increase completion of face-to-face certification by hospital physicians at discharge using a retrospective chart review. We found a shift in the source and timeliness of certification among intervention hospitals. Pre-intervention, hospital physicians completed face-to-face certifications for 18.7% of patients and community physicians completed certifications for 47.2% ( p < .001), compared with 44.4% and 24.3% ( p < .001) post-intervention. Shifting the source of certification from community to hospital physicians helped HHAs by reducing the burden of tracking down certification from community physician offices and facilitating timely care for recently hospitalized patients.

589 Methadone in Procedural Care for Burn Injuries of 20–30% Total Burn Surface Area: A Retrospective Chart Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S146-S146
Author(s):  
Loryn Taylor ◽  
Kimberly Maynell ◽  
Thanh Tran ◽  
David J Smith
Keyword(s):  
Physical Therapy ◽  
Postoperative Pain ◽  
Pain Intensity ◽  
Surface Area ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Opioid Consumption ◽  
Burn Injuries ◽  
Methadone Group ◽  
Significant Difference

Abstract Introduction Prolonged opioid usage remains a concern in pain management in procedural care. Recent evidence also suggests that a considerable number of patients who were prescribed opioids struggle with transitioning to non-opioid pain medications. As a continuous effort to reduce opioid consumption following burn surgical procedures, our institution recently evaluated methadone administration for burn procedural care in patients with 20–30% total burn surface area (TBSA) requiring excision and grafting. Methods After IRB approval, we performed a retrospective chart review of patients who underwent excision and grafting procedure for 20–30% TBSA burn injuries between January 1, 2019 and June 30, 2020. The following data was evaluated: postoperative opioid consumption, postoperative pain intensity (rated as “No Pain” [NRS=0], “Minor Pain” [NRS 1 to 3], “Moderate Pain” [NRS 4 to 6], “Severe Pain” [NRS 7 to 10]), time to physical therapy and time to hospital discharge. Data was analyzed using chi square/Fisher exact test for categorical variables and t-test/Wilcoxon rank sum test for continuous variables. Results Our preliminary data included 12 patients who met inclusion criteria, of which two patients received methadone administration. Our patient sample consisted of average age of 43 years, 75% male, and 24% TBSA (92% were flame burns). Patients in both methadone and non-methadone groups had no significant differences in medical histories and TBSA (23% TBSA in methadone, 25% TBSA in non-methadone). There was no significant difference in reported preoperative pain intensity between the two groups, rating moderate to severe. Postoperative pain intensity remained the same, rating moderate to severe and controlled with fentanyl, oxycodone, morphine and non-opioid analgesics. While there was no difference in postoperative fentanyl, opioid and non-opioid analgesic consumptions between the two groups, morphine consumption was significantly lower in the methadone group compared to non-methadone group (2±2 mg vs 51±54 mg, respectively, p=0.02). There was no significant difference between average time from surgery to first physical therapy session and time to hospital discharge (about 21 days after surgery) between the two groups. Conclusions This evaluation shows a potential trend in reduction of inpatient postoperative opioid consumption with the conjunctive administration of methadone, although a bigger sample size is needed for further assessment.

Examining the Effectiveness of OT in the Treatment of Patients Recovering From COVID-19 in the Rehabilitation Setting

2021 ◽  
Vol 75 (Supplement_2) ◽  
pp. 7512505157p1-7512505157p1
Author(s):  
Nelle Hannah Ouellette ◽  
Leah Bellinger ◽  
Julie Leonard
Keyword(s):  
Pilot Study ◽  
Daily Living ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Inpatient Rehabilitation ◽  
Assessment Instrument ◽  
Patient Assessment ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility ◽  
Primary Author

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. A pilot study was completed to examine the effectiveness of OT in helping individuals regain independence in activities of daily living after COVID-19. In a retrospective chart review, statistically significant results (p &lt; .05) on the Inpatient Rehabilitation Facility Patient Assessment Instrument and the Modified Barthel Index demonstrated that OT is effective in the rehabilitation setting to increase individuals' independence following a COVID-19 diagnosis. Primary Author and Speaker: Nelle Hannah Ouellette Additional Authors and Speakers: Leah Bellinger, Julie Leonard Contributing Authors: Leah Bellinger, Julie Leonard

scholarly journals Combined Topical and Oral Antimicrobial Therapy for the Eradication of Methicillin-ResistantStaphylococcus aureus(Mrsa) Colonization in Hospitalized Patients

2002 ◽  
Vol 13 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Scott K Fung ◽  
Marie Louie ◽  
Andrew E Simor
Keyword(s):  
Medical Devices ◽  
Antimicrobial Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Urinary Catheters ◽  
Mupirocin Ointment ◽  
Mrsa Colonization

OBJECTIVE: How to eradicate methicillin-resistantStaphylo-coccus aureus(MRSA) colonization in hospitalized patients is uncertain. We reviewed our experience with MRSA decolonization therapy in hospitalized patients.SETTING: An 1100-bed, university-affiliated tertiary care teaching hospital in Toronto, Ontario.DESIGN: Retrospective chart review of 207 adult inpatients with MRSA colonization hospitalized between February 1996 and March 1999.INTERVENTIONS: All patients with MRSA colonization were assessed for possible decolonization therapy with a combination of 4% chlorhexidine soap for bathing and washing, 2% mupirocin ointment applied to the anterior nares three times/day, rifampin (300 mg twice daily) and either trimethoprim/sulfamethoxazole (160 mg/800 mg twice daily) or doxycycline (100 mg twice daily). This treatment was given for seven days.RESULTS: A total of 207 hospitalized patients with MRSA colonization were identified and 103 (50%) received decolonization therapy. Patients who received decolonization therapy were less likely than untreated patientsto have intravenous (P=0.004) or urinary catheters (P<0.001), or extranasal sites of colonization (P=0.001). Successful decolonization was achieved in 90% of the 43 patients who were available for at least three months of follow-up.CONCLUSIONS: Combined topical and oral antimicrobial therapy was found to be effective in eradicating MRSA colonization in selected hospitalized patients, especially those without indwelling medical devices or extranasal sites of colonization.

scholarly journals G6PD deficiency and severity of COVID19 pneumonia and acute respiratory distress syndrome: tip of the iceberg?

2020 ◽  
Author(s):  
Jihad G. Youssef ◽  
Faisal Zahiruddin ◽  
George Youssef ◽  
Sriram Padmanabhan ◽  
Joe Ensor ◽  
...  
Keyword(s):  
G6pd Deficiency ◽  
Chart Review ◽  
Ventilatory Support ◽  
Severe Pneumonia ◽  
Retrospective Chart Review ◽  
The Elderly ◽  
Supplemental Oxygen ◽  
Redox Status ◽  
Clinical Series ◽  
Viral Proliferation

Abstract The severe pneumonia caused by human coronavirus (hCoV)-SARS-CoV-2 has inflicted heavy causalities, especially among the elderly and those with comorbid illnesses irrespective of age. The high mortality in African Americans and males, in general, raises concern for a possible X-linked mediated process that could affect viral pathogenesis and the immune system. We hypothesized that G6PD, the most common X-linked enzyme deficiency associated with redox status, may have a role in the severity of pneumonia. A retrospective chart review was performed in hospitalized patients with COVID19 pneumonia needing supplemental oxygen. A total of 17 patients were evaluated: six with G6PD deficiency and 11 with normal levels. The two groups (normal and G6PD def) were comparable in terms of age, sex and comorbidities and laboratory parameters LDH, IL-6, CRP, and ferritin. Thirteen patients needed ventilatory support, with 6 in the G6PD group (83% vs. 72%). The main differences indicating increasing severity in the G6PD def group included G6PD levels (12.2 vs. 5.6, P=0.0002), PaO2/FiO2 ratio (159 vs. 108, P=0.05), days before intubation (2.5 vs. 4.8 P= 0.03), days on mechanical ventilation (10.25 vs. 21 days P=0.04), hemoglobin level (10 vs. 8.1 P=0.03) and hematocrit (32 vs. 26 P=0.015). Only one patient with G6PD deficiency died; 16 were discharged home. Our clinical series ascribes a possible biological role for G6PD deficiency in SARS-CoV2 viral proliferation. It is imperative that further studies be performed to understand the interplay between the viral and host factors in G6PD deficiency that may lead to disparity in outcomes.

scholarly journals Measuring Functional Change in Children With Acquired Brain Injury (ABI): Comparison of Generic and ABI-Specific Scales Using the Pediatric Evaluation of Disability Inventory (PEDI)

2003 ◽  
Vol 83 (9) ◽  
pp. 776-785 ◽  
Author(s):  
Dhara H Kothari ◽  
Stephen M Haley ◽  
Kathleen M Gill-Body ◽  
Helene M Dumas
Keyword(s):  
Chart Review ◽  
Brain Injuries ◽  
Self Care ◽  
Retrospective Chart Review ◽  
Inpatient Rehabilitation ◽  
Functional Change ◽  
Functional Changes ◽  
Measuring Change ◽  
General Order ◽  
Future Work

Background and Purpose. The Pediatric Evaluation of Disability Inventory (PEDI) subscales are hierarchic in nature, with item placements within each subscale reflecting the general order of skill attainment in children without disabilities. The purpose of this study was to determine whether a hierarchical subscale developed in this study for children with acquired brain injuries (ABIs) corresponds to the generic PEDI subscales, and, if not, whether condition-specific (ABI-specific) PEDI subscales are more sensitive for measuring change. Subjects. Eighty-seven children and adolescents (mean age=9.2 years, SD=5.2, range=1–20) with ABI during inpatient rehabilitation admissions were included. Methods. Data were collected by retrospective chart review. Rasch one-parameter analyses were conducted to construct the ABI-specific PEDI scale focusing on the Mobility and Self-care domains (content areas) only. Each domain consists of a Functional Skills subscale and a Caregiver Assistance subscale. Thus, in all, 4 scales were constructed within the ABI-specific PEDI scale. Differences in item hierarchies and sensitivity between generic and ABI-specific PEDI subscales for each domain were then examined. Results. Both generic and ABI-specific PEDI scales were sensitive for measuring functional changes during inpatient rehabilitation hospitalization. Even though the generic and ABI-specific item hierarchies differed substantially, only one of the 4 ABI-specific PEDI subscales (Caregiver Assistance Self-care subscale) was more sensitive for measuring change than the generic PEDI scale. Discussion and Conclusion. The ABI-specific scales added relatively little improvement in sensitivity compared with the generic PEDI scales of the Mobility and Self-care domains. Thus, for group analyses, the authors recommend use of the generic PEDI subscales for children with ABI. Future work with ABI-specific subscales may improve the physical therapist's ability to describe an individual's pattern of functional recovery.

Effect of Implementing Quantitative Blood Loss Assessment at the Time of Delivery

2019 ◽  
Vol 36 (13) ◽  
pp. 1332-1336
Author(s):  
Elizabeth Coviello ◽  
Sara Iqbal ◽  
Tetsuya Kawakita ◽  
Rebecca Chornock ◽  
Megan Cheney ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Chart Review ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Loss Assessment ◽  
Estimated Blood Loss ◽  
Better Than

Objective To evaluate the ability of estimated blood loss (EBL) and quantitative blood loss (qBL) to predict need for blood transfusion in women with postpartum hemorrhage (PPH). Study Design This is a retrospective chart review that identified women with PPH (>1,000 mL for vaginal or cesarean delivery) between September 2014 and August 2015, reported by EBL (n = 92), and October 2015 and September 2016, reported by qBL (n = 374). The primary metric was the area under the receiver-operating characteristic curve for blood transfusion. Results The rate of PPH by EBL and qBL was 2.8 and 10.8%, respectively (p < 0.01). The rate of transfusion for women meeting criteria for PPH by EBL and QBL were 2% (66/3,307) and 2.7% (93/3,453), respectively (p = 0.06). Postpartum transfusion was predicted by an EBL of 1,450 mL with AUC 0.826 and qBL 1,519 mL with AUC 0.764, for all modes of delivery. Postpartum vital signs and change in pre- and postdelivery hematocrit were poor predictors for transfusion. Conclusion The rates of PPH increased with the implementation of qBL. Overall, qBL did not perform better than EBL in predicting the need for blood transfusion.

Characteristics of Hospitalized Patients Screening Positive for Delirium

2019 ◽  
Vol 37 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Trinh H. Nguyen ◽  
Rabia S. Atayee ◽  
Katrina L. Derry ◽  
Jeremy Hirst ◽  
Anthony Biondo ◽  
...  
Keyword(s):  
Chart Review ◽  
Average Length ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Hospitalized Patients ◽  
Screening Tools ◽  
Inpatient Stay ◽  
Tertiary Referral ◽  
Average Length Of Stay ◽  
General Psychiatry

Background: Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations. Objective: To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use. Design, Settings, Patients: Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized. Measurements: Patients’ demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams’ involvement. Results: Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations. Conclusion: In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.

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