Biomechanism and exercise effect of fitness walking using twin walking sticks

In Japan, walking poles with pairs of sticks developed exclusively for fitness walking have been designed. A new concept of walking style (WS) has been conceived using these walking sticks to “effectively” walk around the city, comprehensive sports parks, or at rehabilitation hospitals. Stick manufacturers are promoting its health benefits; however, evidence supporting these claims is lacking. Hence, this study aimed to measure the influence of walking sticks and evaluate the exercise effect based on functional physical fitness related to WS characteristics. The participants were 12 WS instructors. They engaged in WS at a comfortable speed after walking normally at the same speed (WN) for ∼5 m (seven times), followed by WS again. The walking speed, step length, stride width, walk ratio, one-leg support time, and trajectory of the center of gravity (CG) (in the horizontal and vertical directions of one walking cycle) calculated from the whole-body skeleton model were analyzed. The gait of WS increased the step length, step width, and walking ratio as compared with that of WN (p<0.05). WS likely reduce cadence and one-leg support time (p<0.05). The CG locus in the left-right direction showed no significant differences between WS and WN. The maximum value of the CG locus in the vertical direction was high in WS (p<0.05). WS can be used as a navigation training tool that improves a walker's exercise efficiency and left-right leg coordination, thereby improving walking posture. This may help reduce the anxiety due to injuries and pain that may occur while walking.

40. Impact of an Antimicrobial Intake Process within a Post-acute Medical System

Background Implementation of antimicrobial stewardship programs (ASPs) within long-term acute care facilities (LTACs) is challenging due to limited resources and missing patient data from transferring facilities. In October 2018, an ASP was established within a 43-hopital system consisting of LTACs and rehabilitation hospitals. Despite the presence of a restricted antimicrobial policy, increased utilization was observed for five restricted antimicrobials. The system ASP committee implemented a multipronged approach to optimize utilization of these five agents. Investigators sought to assess the impact of an antimicrobial intake process on antimicrobial consumption. Methods This was a retrospective analysis within a 43-hospital system of LTACs and rehabilitation hospitals, comparing use of five restricted antibiotics before (Jul19-Jun20) and after (Jul20-Apr21) implementation of a data-collection and system review process. An antibiotic intake form and process for review for five restricted antibiotics (ceftaroline, ceftazidime/avibactam, ceftolozane/tazobactam, fidaxomicin, meropenem/vaborbactam) was approved at the system ASP committee. The intake form consisted of a restricted antibiotic form, cultures and susceptibilities, physician notes, and other pertinent data. Any orders for the five antibiotics required completion of an intake form and submission to system ASP members for review and recommendations. Antibiotic consumption was measured in cost per acute patient day (cost/pd) using a 2-sided t-test. Results Post-implementation, the five restricted antibiotics comprised 29.1% of the total antibiotic expenditure for the healthcare system compared to 35.6% pre-implementation. Ten months after program implementation, the total antibiotic cost/PD decreased 29.45% [(&12.02 ± 2.29) vs. (&8.48 ± 1.45); p=0.0003]. The cost/PD of the five restricted antibiotics decreased 42.52% [(&4.28 ± 1.09) vs. (&2.46 ± 0.99) ; p=0.0005]. Conclusion Implementation of an antimicrobial intake process within a post-acute medical system resulted in a significant reduction in antibiotic consumption for five targeted antibiotics as well as overall antibiotic expenditure. Disclosures All Authors: No reported disclosures

Neuropsychological rehabilitation, neuroimaging and neuroplasticity: A clinical commentary

Initial brain imaging studies on recovery of motor functioning after stroke suggested their potential prognostic value in neurorehabilitation. However, the value of brain imaging in documenting brain changes associated with cognitive and behavioral treatment effects seem less likely. Also, neuroimaging studies at that time seem to have little, if any, value for treatment planning. Advances in neuroimaging technology are beginning to challenge these initial impressions. In this clinical commentary, we propose that advances in the field of neuroimaging have relevance for the future development of neuropsychological rehabilitation. Neuropsychological rehabilitation is entering a new era which involves collaboration with neuroimaging and associated studies on neuroplasticity. We recognize that this may seem “aspirational” rather than practical in most rehabilitation settings. However, we provide examples of how this can be achieved as illustrated by collaborative efforts of clinicians and scientists in the SARAH Network of Rehabilitation Hospitals in Brazil. We also review selective papers on neuroplasticity, spontaneous recovery and diaschisis that have relevance for research which will expand and further develop the field of neuropsychological rehabilitation.

Analysis of Exposure To Radon in Bulgarian Rehabilitation Hospitals

Mineral springs are used in spa resorts throughout the world. Radon is a natural radioactive source, which can dissolve, accumulate, and be transported by water. This study investigates the radon concentration in air and water in 12 Bulgarian rehabilitation hospitals and presents the assessment of the exposure to radon in them. The measurements were performed at 401 premises within 21 buildings, using two types of passive detectors for a dry and wet environment that were exposed from February, 2019 to June, 2019. The radon concentration varied from 19 to 2550 Bq/m3 with an arithmetic mean and a standard deviation of 102 Bq/m3 and 191 Bq/m3, respectively. The hypothesis that in hospitals the source of radon, besides soil under the buildings, is also the mineral water that is used for treatment, was tested. Thermal water samples were procured sequentially from a spring and baths to analyse the reduction of radon concentration in them till reaching the premises. The results show that the concentration of radon decreased by approximately 50%. Further, the correlation analysis applied to the data proved the relation of the levels of indoor radon in the treatment rooms with those in the water. Mineral water used in rehabilitation hospitals have radon transfer coefficients ranging from 4.5·10− 4 to 8.4·10− 3. In addition, an analysis of the exposure of patients and workers to radon in rehabilitation hospitals based on the indoor radon levels and period of exposure was performed.

Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation

Background Traditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process. Methods Twenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: penetration and fidelity of the intervention, change in patient-centred processes, patient and provider satisfaction and experience, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations. Results Of 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and high fidelity were associated with higher penetration. PODS improved family involvement during discharge teaching (7% increase, p = 0.026), use of teach-back (11% increase, p < 0.001) and discussion of help needed (6% increase, p = 0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant. Conclusions This project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.