Abstract P35: The Trend of Stroke Rehabilitation Utilization Between 2014- 2019 in a Community Based Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel Uhm ◽  
Esther Olasoji ◽  
Alexis N Simpkins ◽  
Carolyn Geis ◽  
Keyword(s):  
Clinical Practice ◽  
Trend Analysis ◽  
Significant Proportion ◽  
Inpatient Rehabilitation ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Institutional Review ◽  
Ischemic Attack ◽  
Over Time

Introduction: Stroke is the leading cause of long-term disability in adults, resulting in significant impairments in motor, sensory, and/ or cognitive that often requires continued rehabilitation services, which vary from intensive acute inpatient rehabilitation to outpatient rehabilitation services. Efforts to reduce disability have advanced rapidly over the past several years. Our data analysis was undertaken to assess whether recent changes in clinical practice have impacted the proportion of stroke patients receiving inpatient versus outpatient rehabilitation over time between 2014-2019 at our institution, which serves a diverse mix of rural, suburban, and urban populations. Methods: Our Institutional Review Board approved retrospective stroke database, including adult patients discharged to receive rehabilitation services data from 2014-2019, was used for analysis. Cochran-Armitage trend analysis was used to assess for differences type of rehabilitation services used over time and regression analysis was used to identify clinical factors associated with discharge type over time. Results: A total of 3467 patients were included in the analysis, 50% woman, 1% Asian, 20% Black, 75% White, 4% undetermined race, 17% intracerebral hemorrhage, 65% ischemic stroke, 11% subarachnoid hemorrhage, 3% transient ischemic attack, 3% other cerebrovascular disease. In this community population, 65% were discharged to inpatient rehab. Trend analysis demonstrated a significant increase in the proportion of patients being discharged home with rehab services, p<.0001. In comparison to those discharged home, patients discharged to rehab were older (odds ratio (OR) 1.02, confidence interval (CI) 1.02-1.03), with a higher NIHSS (OR 1.16, CI 1.14-1.18), discharged in 2014 (OR 1.72, CI 1.23-2.39) or 2016 (OR 1.46, CI 1.05-2.05) versus 2019. There was no association with race, gender, or discharge in 2015, 2017, or 2018. Discussion: Our findings demonstrate the community impact of recent changes in clinical practice guidelines for stroke. The increasing trend of home discharges is encouraging, but the significant proportion of those still not discharged home suggests there is still more work to be done to reduce stroke associated disability in adults.

scholarly journals Considerations for Postacute Rehabilitation for Survivors of COVID-19

10.2196/19462 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e19462 ◽  
Author(s):  
Lisa Mary Sheehy
Keyword(s):  
Treatment Plan ◽  
Inpatient Rehabilitation ◽  
Careful Consideration ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Speech Language Pathology ◽  
Language Pathology ◽  
Rehabilitation Needs ◽  
And Function

Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible.

scholarly journals Considerations for Postacute Rehabilitation for Survivors of COVID-19 (Preprint)

2020 ◽  
Author(s):  
Lisa Mary Sheehy
Keyword(s):  
Treatment Plan ◽  
Inpatient Rehabilitation ◽  
Careful Consideration ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Speech Language Pathology ◽  
Language Pathology ◽  
Rehabilitation Needs ◽  
And Function

UNSTRUCTURED Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible.

Acute and Long-Term Services for Elementary and Middle School Children With Early Childhood Brain Injury

2021 ◽  
Vol 30 (2S) ◽  
pp. 908-919
Author(s):  
Jessica Salley ◽  
Libby Crook ◽  
Taylor Iske ◽  
Angela Ciccia ◽  
Jennifer P. Lundine
Keyword(s):  
Middle School ◽  
Special Education ◽  
Early Childhood ◽  
Brain Injury ◽  
Acute Care ◽  
Rehabilitation Services ◽  
Elementary And Middle School ◽  
Specific Education ◽  
Over Time

Purpose The purpose of this study was to investigate the rates of referral to and receipt of acute and long-term services and identify factors that could impact these rates for children who experienced an acquired brain injury (ABI) during early childhood who are now in elementary and middle school. Method This was a retrospective chart review and prospective phone survey of 29 caregivers of children with ABIs. Results Acutely, two thirds of this sample received hospital-based rehabilitation services, but only 44.8% of families reported receiving ABI-specific education or a referral to educational or rehabilitation services at the time of discharge. At an average of 8.5 years postinjury, children in this sample were largely reported to be performing positively in school. While special education rates did not change significantly over time, 20.7% of the sample reported having unmet educational needs. Additionally, service receipt decreased over time. Various injury and educational factors influenced rates of long-term special education and service receipt. Conclusions This study contributes to the emerging literature focusing on long-term outcomes of children with ABI. The results reinforce that children who experience an ABI in early childhood are unlikely to receive ABI-specific education or referrals to educational and rehabilitation services during their acute-care stay and, in the chronic stages of recovery, present with educational and therapy needs that can go unmet. To improve long-term service access for children who experience an early ABI, pathways need to be established within the acute-care setting for education and referrals that connect the child and family to treatment within early intervention and educational systems. Maintaining these pathways long term, particularly for potential social-behavioral and cognitive-communication concerns, could increase access to appropriate services and, thus, decrease unmet needs for children with ABI.

scholarly journals Trend Analysis of Lakes and Sinkholes in Konya Closed Basin, Turkey

2021 ◽  
Author(s):  
Vahdettin DEMIR
Keyword(s):  
Trend Analysis ◽  
Flood Control ◽  
Statistical Tests ◽  
Water Levels ◽  
Trend Test ◽  
Lake Levels ◽  
Closed Basin ◽  
Thiessen Polygons ◽  
Over Time

Abstract Determining changes in the water level of lakes is essential in terms of flood control, water resource management, economic development, water-supply planning sustainability, and the sustainability of the ecosystem. Trend analysis is one of the most commonly used tools for detecting changes in the hydrological time series such as lake levels, precipitation and temperature. Trend analyses of meteorological variables and groundwater levels (baseflow components) are crucial toward the assessment of long-term changes in lake levels. This study aims to investigate the trend of long-term change in lakes (Lake Tuz and Lake Beyşehir) and sinkholes (Timraş and Kızören) in the Konya Closed Basin in Turkey. Changes in these lakes and sinkholes were examined along with changes in precipitation and groundwater trends representing the climate in the region. With the assistance of Thiessen polygons, precipitation stations, which affect the lakes and sinkholes, were determined. Several statistical tests exist that help determine the significance of hydrological trends over time. These tests are divided into two categories: parametric and nonparametric. In this study, the non parametric Innovative Sen trend test, the Modified Mann–Kendall trend test, and the parametric Linear Trend test were used. As a result of the trend analysis, it was observed that the water levels of Kızören and Timraş sinkholes decreased over time, and the water levels of Tuz Gölü and Beyşehir lakes increased over time. These results are supported by the trends of precipitation data and groundwater level data of the stations determined by the Thiessen polygons and sub-basin boundaries.

Reduction in Stroke After Transient Ischemic Attack in a Province-Wide Cohort Between 2003 and 2015

2020 ◽  
pp. 1-9
Author(s):  
Ryan Wang ◽  
Arunima Kapoor ◽  
Patrice Lindsay ◽  
Cristina Goia ◽  
Amy Y. X. Yu ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Mortality Rates ◽  
Canadian Institute ◽  
Trends Over Time ◽  
Level 1 ◽  
Ischemic Attack ◽  
Event Rates ◽  
Linear Regressions ◽  
Over Time

ABSTRACT: Background: Improvements in management of transient ischemic attack (TIA) have decreased stroke and mortality post-TIA. Studies examining trends over time on a provincial level are limited. We analyzed whether efforts to improve management have decreased the rate of stroke and mortality after TIA from 2003 to 2015 across an entire province. Methods: Using administrative data from the Canadian Institute for Health Information’s (CIHI) databases from 2003 to 2015, we identified a cohort of patients with a diagnosis of TIA upon discharge from the emergency department (ED). We examined stroke rates at Day 1, 2, 7, 30, 90, 180, and 365 post-TIA and 1-year mortality rates and compared trends over time between 2003 and 2015. Results: From 2003 to 2015 in Ontario, there were 61,710 patients with an ED diagnosis of TIA. Linear regressions of stroke after the index TIA showed a significant decline between 2003 and 2015, decreasing by 25% at Day 180 and 32% at 1 year (p < 0.01). The 1-year stroke rate decreased from 6.0% in 2003 to 3.4% in 2015. Early (within 48 h) stroke after TIA continued to represent approximately half of the 1-year event rates. The 1-year mortality rate after ED discharge following a TIA decreased from 1.3% in 2003 to 0.3% in 2015 (p < 0.001). Interpretation: At a province-wide level, 1-year rates of stroke and mortality after TIA have declined significantly between 2003 and 2015, suggesting that efforts to improve management may have contributed toward the decline in long-term risk of stroke and mortality. Continued efforts are needed to further reduce the immediate risk of stroke following a TIA.

scholarly journals Are people consistent when reading nonwords aloud on different occasions?

2021 ◽  
Author(s):  
Anastasia Ulicheva ◽  
Max Coltheart ◽  
Oxana Grosseck ◽  
Kathleen Rastle
Keyword(s):  
Clinical Practice ◽  
Reading Skill ◽  
Writing System ◽  
Considerable Variability ◽  
Nonword Reading ◽  
Theories Of Reading ◽  
Over Time ◽  
The Way

AbstractTests of nonword reading have been instrumental in adjudicating between theories of reading and in assessing individuals’ reading skill in educational and clinical practice. It is generally assumed that the way in which readers pronounce nonwords reflects their long-term knowledge of spelling–sound correspondences that exist in the writing system. The present study found considerable variability in how the same adults read the same 50 nonwords across five sessions. This variability was not all random: Nonwords that consisted of graphemes that had multiple possible pronunciations in English elicited more intraparticipant variation. Furthermore, over time, shifts in participants’ responses occurred such that some pronunciations became used more frequently, while others were pruned. We discuss possible mechanisms by which session-to-session variability arises and implications that our findings have for interpreting snapshot-based studies of nonword reading. We argue that it is essential to understand mechanisms underpinning this session-to-session variability in order to interpret differences across individuals in how they read nonwords aloud on a single occasion.

scholarly journals Characteristics of patients discontinuing outpatient services under long-term care insurance and its effect on frailty during COVID-19

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11160
Author(s):  
Tamaki Hirose ◽  
Yohei Sawaya ◽  
Takahiro Shiba ◽  
Masahiro Ishizaka ◽  
Ko Onoda ◽  
...  
Keyword(s):  
Older Adults ◽  
Long Term Care ◽  
Walking Speed ◽  
Community Dwelling ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Term Care ◽  
Long Term Care Insurance ◽  
Community Dwelling Older Adults

Background Among community-dwelling older adults who require long-term care and use outpatient rehabilitation services, we aimed to examine the characteristics of patients who discontinued using outpatient rehabilitation services to prevent exposure to COVID-19 and the effects of this discontinuation on patient frailty. Methods Participants were 119 older adults (69 males, 50 females; average age 77.3 ± 8.3 years) requiring long-term care who used outpatient rehabilitation services. Our outpatient rehabilitation service involved day care for older adults undergoing rehabilitation including pick-up and drop-off services under the long-term care insurance system. They were divided into two groups: participants who discontinued using outpatient rehabilitation services and participants who continued their use. To find the factors associated with this discontinuation, binomial logistic regression analysis was performed, in which the following independent variables were used: gender, age, height, weight, long-term care level, grip strength, and normal walking speed. Frailty status was investigated in April 2020 and again in September 2020 through interviews and telephone surveys utilizing the Frailty Screening Index. Results Women and normal walking speed were independent factors associated with the discontinuation of outpatient rehabilitation due to COVID-19. According to the results of the Frailty Screening Index, similar tendencies were exhibited in both April and September. The discontinued group indicated that they were getting less exercise and having stronger feelings of fatigue than the continuing group. Conclusions The findings are in accordance with other studies indicating that women are more likely to employ prevention measures against COVID-19, as seen among the community-dwelling older adults requiring long-term care who used outpatient rehabilitation services. People with higher levels of physical function were also likely to refrain from using outpatient rehabilitation services. Results further suggested that the discontinued group had more frailty-related factors (i.e., low physical activity and strong exhaustion) than the continuing group.

scholarly journals Impact of the First Generation of Children’s Oncology Group Clinical Trials on Clinical Practice for Wilms Tumor

2021 ◽  
Vol 19 (8) ◽  
pp. 978-985
Author(s):  
Jeffrey S. Dome ◽  
Elizabeth A. Mullen ◽  
David B. Dix ◽  
Eric J. Gratias ◽  
Peter F. Ehrlich ◽  
...  
Keyword(s):  
Clinical Practice ◽  
First Generation ◽  
Renal Tumor ◽  
Wilms Tumor ◽  
Lung Nodule ◽  
Significant Proportion ◽  
Oncology Group ◽  
Treatment Regimens ◽  
Tumor Studies

Refinements in surgery, radiation therapy, and chemotherapy since the mid-20th century have resulted in a survival rate exceeding 90% for patients with Wilms tumor (WT). Although this figure is remarkable, a significant proportion of patients continue to have event-free survival (EFS) estimates of <75%, and nearly 25% of survivors experience severe chronic medical conditions. The first-generation Children’s Oncology Group (COG) renal tumor trials (AREN ‘0’), which opened to enrollment in 2006, focused on augmenting treatment regimens for WT subgroups with predicted EFS <75% to 80%, including those with the adverse prognostic marker of combined loss of heterozygosity (LOH) at chromosomes 1p/16q, pulmonary metastasis with incomplete lung nodule response after 6 weeks of chemotherapy, bilateral disease, and anaplastic histology. Conversely, therapy was reduced for patient subgroups with good outcomes and potential for long-term toxicity, such as those with lung metastasis with complete lung nodule response after 6 weeks of chemotherapy. This article summarizes the key findings of the first-generation COG renal tumor studies and their implications for clinical practice.

scholarly journals Rehabilitation During COVID-19 Pandemic: An Indian Perspective

2020 ◽  
pp. 1-4
Author(s):  
Harleen Uppal ◽  
Siddharth Rai
Keyword(s):  
Respiratory Illness ◽  
Outpatient Rehabilitation ◽  
Rehabilitation Services ◽  
Icu Stay ◽  
Resource Limited ◽  
Interdisciplinary Rehabilitation ◽  
Care Facilities ◽  
Prolonged Icu Stay

ABSTRACT It has been noted that as high as 20.3% of patients hospitalized for coronavirus disease 2019 (COVID-19) require intensive care unit (ICU) admission. This has most commonly been attributed to the development of acute respiratory distress syndrome. These patients require prolonged periods of ICU stay, averaging approximately 20 days. As people recover and are discharged, there will be a new pandemic of critical illness survivors. These patients would present with impairments and disabilities arising because of prolonged ICU stay as well as consequences of severe respiratory illness. The longer the duration of ICU stay, the higher is the risk for long-term physical, cognitive, and emotional impairments needing comprehensive and early rehabilitation. This article focuses on the indispensable role of early and interdisciplinary rehabilitation in effective disaster management, restoring functions, and improving quality of life in COVID survivors. It outlines how to practically expand rehabilitation services in a resource-limited country, such as India, and lists the limitations being faced that prevent the uniform application of rehabilitation services in India. This would help to deal with the rapid increase in demand of postacute care facilities, be it in hospital services, in the form of inpatient or outpatient rehabilitation or home care facilities, including telemedicine.

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