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Abstract Dysphagia, a disorder affecting the ability to swallow, has a high prevalence among the older adults and can lead to serious health complications. Therefore, early detection of dysphagia is important. This study evaluated the effectiveness of a newly developed deep learning model that analyzes syllable-segmented data for diagnosing dysphagia, an aspect not addressed in prior studies. The audio data of daily conversations were collected from 16 patients with dysphagia and 24 controls. The presence of dysphagia was determined by videofluoroscopic swallowing study. The data were segmented into syllables using a speech-to-text model and analyzed with a convolutional neural network to perform binary classification between the dysphagia patients and control group. The proposed model in this study was assessed in two different aspects. Firstly, with syllable-segmented analysis, it demonstrated a diagnostic accuracy of 0.794 for dysphagia, a sensitivity of 0.901, a specificity of 0.687, a positive predictive value of 0.742, and a negative predictive value of 0.874. Secondly, at the individual level, it achieved an overall accuracy of 0.900 and area under the curve of 0.953. This research highlights the potential of deep learning modal as an early, non-invasive, and simple method for detecting dysphagia in everyday environments.

IntroductionCaregiver preparedness is defined as the perceived preparation of caregivers to care for the physical and emotional needs of the patient.PurposeThis study investigated caregiver preparedness and its influences on caregiver burden, depression, and quality of life (QoL) in caregivers of individuals with disabilities.MethodsWe conducted a multicenter cross-sectional survey study on caregivers caring for patients with disabilities. Sociodemographic characteristics were collected via questionnaires. The Preparedness for Caregiving Scale (PCS), Burden Interview (BI), Center for Epidemiologic Studies Depression Scale (CES-D), and EuroQol-Visual Analogue Scale (EQ-VAS) were administered.ResultsA total of 151 caregivers were enrolled. The mean age of caregivers was 53.7 ± 12.4 years, and 80.8% were female. The majority of participants were the main caregivers of patients with stroke, spinal cord injury, or traumatic brain injury. The mean PCS score was 2.1 ± 0.9, demonstrating significant relationships with BI (r = −0.512, p

Objective To investigate variables for assessment of stroke-related sarcopenia that are alternative options to the current assessment for sarcopenia, which focuses on age-related sarcopenia and also has limitations in addressing sarcopenia due to weakness resulting from stroke. Methods Forty patients (17 men, 23 women; mean age, 66.9±15.4 years) with first-ever stroke who can walk independently were included. Muscle mass was determined by measuring ultrasonographic muscle thickness of vastus intermedius, rectus femoris, tibialis anterior, medial gastrocnemius, and biceps brachii muscles in addition to using the skeletal muscle index (SMI) with bioelectrical impedance analysis. Muscle strength was assessed with the Medical Research Council (MRC) sum score as well as handgrip (HG) strength. Physical performance was measured by the Berg Balance Scale (BBS) along with 4-meter gait speed (4MGS). Correlations between each assessment in the three categories were analyzed and adjusted by stroke severity, comorbidity, and nutritional status. Results For muscle mass, SMI showed the highest correlation with the tibialis anterior muscle (r=0.783, p

Abstract Background In the age of aging, Korea’s current medical delivery system threatens to increase the number of medical and caring refugees. This study attempts to develop an integrated senior citizen-oriented healthcare service system in which daily care, professional care, and rehabilitation are organically organized between medical institutions and local communities, thereby meeting the daily life needs of the elderly and inducing well-being, wellness, and well-dying. Methods To develop the integrated healthcare system, data collection and analyses were conducted through a systematic review, literature review, benchmarking, focus group interviews, and expert consultation. Results The senior-specific, citizen-oriented healthcare service system developed in this study is designed to screen patients aged 65 or older within 24 h of being admitted, using the Geriatric Screening for Care-10. If there is reason for concern as a result of the screening, further evaluation is performed through assessment. Doctors and nurses create a care plan and a discharge plan based on the results from the screening and assessment. The nurse further uses the screening to monitor the patient’s condition before discharge. Based on the screening results at the time of discharge, a transitional care plan is prepared and provided to elderly patients and/or their families. This process enables a systematic link between medical institutions and community resources, aiming for the continuous management of health issues. It also establishes a multidisciplinary treatment plan that considers patients and their families so that diseases common to the elderly are diagnosed and treated promptly. Conclusions The most important issue for the elderly is to be able to live healthily and independently for the rest of their lives through well-being, wellness, and well-dying. The senior-specific, citizen-oriented healthcare service proposed in this study is an integrated medical treatment system for elderly users the implementation of which requires the daily care, professional care, and rehabilitation of elderly members of society to be organically organized according to the role of the patients, their families, and the caregiver.

Abstract Background Aging is an inevitable part of life. One can maintain well-being and wellness even after discharge and/or transition if his or her functional decline is minimized, sudden decline is prevented, and functioning is promoted during hospitalization. Caring appropriately for elderly patients requires the systematic application of Senior-Friendly Hospital principles to all operating systems, including medical centres’ organization and environment, as well as patient treatment processes. The Senior-Friendly Hospital framework is valid and important for patient safety and quality improvement. This study aimed to make recommendations regarding the development of the Korean Framework for Senior-Friendly Hospitals for older patients’ care management, patient safety interventions, and health promotion, via a Delphi survey. Methods Two rounds of Delphi surveying were conducted with 15 participants who had at least 3 years’ experience in accreditation surveying and medical accreditation standards, survey methods, and accreditation investigator education. In each round, we calculated statistics describing each standard’s validity and feasibility. Results The Korean Framework for Senior-Friendly Hospitals included 4 Chapters, 11 categories, and 67 standards through consensus of the Senior-Friendly Hospitals task force and experts’ peer review. After the two rounds of Delphi surveying, validity evaluation led to no changes in standards of the Senior-Friendly Hospitals; however, the number of standards showing adequate validity decreased from 67 to 58. Regarding feasibility, no changes were necessary in the standards; however, the number of categories showing adequate feasibility decreased from 11 to 8 and from 67 to 30, respectively. The excluded categories were 3.2, 4.2, and 4.3 (service, transportation, and signage and identification). The highest feasibility values were given to standards 2.1.1, 4.1.4, and 4.1.6. The highest feasibility score was given to standard 2.4.2. Conclusions The Korean Framework for Senior-Friendly Hospitals needs to include 4 Chapters, 8 categories, and 30 standards. The Accreditation Program for Healthcare Organizations should include Senior-Friendly Hospitals -relevant standards considering Korea’s medical environment.

Objective To evaluate the reliability of the practical life space in post-stroke patients using the Korean version of the Life-Space Assessment (K-LSA) questionnaire and to assess the relationships between the K-LSA and physical function, daily activity, quality of life, and post-stroke depression. Methods The LSA questionnaire was translated into Korean, and the translated version was authorized by the author of the LSA questionnaire. In a cross-sectional study, the performance of the K-LSA was evaluated in 34 stroke patients (20 males and 14 females; mean age 65.11±2.39 years) who were receiving physical and occupational therapy at the outpatient clinic in the rehabilitation medicine department of a university medical center at the time of evaluation. Performances were assessed twice by one examiner at a 2-week interval to test the reliability. The patients were evaluated using the Functional Ambulation Category (FAC) scale, Functional Independence Measure (FIM) scale, and mobility subscale of the FIM to assess their relationships with the K-LSA. They were also evaluated using the EuroQol 5 Dimensions questionnaire (EQ-5D) and Geriatric Depression Scale (GDS) to determine the relationship with quality of life and post-stroke depression. Results Test-retest reliability at the first (62.20±32.14) and second (63.15±32.22) assessment was 0.993 (p<0.01). The K-LSA showed significant correlations with the FAC (r=0.848, p<0.01), FIM (r=0.765, p<0.01), mobility category of the FIM (r=0.764, p<0.01), GDS (r=-0.657, p<0.01), and EQ-5D (r=0.506, p<0.01). Conclusion This study suggests that the practical life space of post-stroke patients, assessed by the K-LSA, has a significant correlation with patients' functional mobility, independence in daily activity, quality of life, and depression. [ABSTRACT FROM AUTHOR]

Introduction: With the increase in the patient survival rates of many types of cancers, a greater proportion of cancer patients live with disease-related problems that diminish their quality of life. This study aimed to investigate the clinical characteristics and rehabilitation of hospitalised cancer patients who were referred to the Department of Physical and Rehabilitation Medicine (PRM) at Samsung Medical Center, a tertiary university hospital in Seoul, Korea.Methods: Hospitalised cancer patients aged > 18 years who were referred to the Department of PRM from January to December 2012 were enrolled in this retrospective study. We reviewed the clinical characteristics of the patients, the principal reasons for their referral and relevant details of their rehabilitative management.Results: A total of 1,340 cases were included. The most common primary cancer was lung cancer (19.0%) and 28.6% of the cases had solid organ metastasis. The most common reason for referral was deconditioning (31.7%), followed by weakness (23.1%) and respiratory problems (14.5%). Bedside exercise was prescribed to 28.4% of the patients, exercise in the rehabilitation therapy unit to 28.0% and pulmonary rehabilitation to 14.3%. Among the 1,340 cases, 107 (8.0%) were transferred to the Department of PRM for comprehensive rehabilitation. The 32 patients with an identifiable Modified Barthel Index score showed significant functional improvement.Conclusion: The findings of the present study contribute to a better understanding of rehabilitation for hospitalised cancer patients. The information obtained will also be helpful in the development of appropriate cancer rehabilitation strategies. [ABSTRACT FROM AUTHOR]

Background and Purpose: High-frequency repetitive transcranial magnetic stimulation (rTMS) aids motor recovery in patients with subacute stroke. However, the response to high-frequency rTMS is highly variable between patients. The aim of this study was to identify the factors associated with improved motor function in response to high-frequency rTMS in subacute stroke patients with moderate to severe upper extremity motor involvement. Methods: Sixty-two patients with subacute stroke were enrolled. rTMS was applied over the primary motor cortex of the affected hemisphere at 10 Hz with 1,000 pulses/day for 10 days. Upper limb motor function was scored with the upper limb of Fugl-Meyer Assessment (FMA-UL) score before intervention and immediately after intervention. All FMA-UL changes greater than or equal to 5 points were considered clinically significant. Potential influencing factors considered included patient characteristics, motor function, corticospinal tract (CST) integrity assessments, and genetics. Multivariate logistic regression analysis was used to identify the significance of each of these factors. Results:We found that the two factors with the greatest impact on the improvement in FMA-UL score were: 1) the functional integrity of the CST, and 2) the brain-derived neurotrophic factor (BDNF) genotype (p < 0.05). Age tended to influence clinically significant changes in the FMA-UL score, although this effect was not significant. Conclusion: Our findings suggest that high-frequency rTMS interventions aimed at improving upper extremity motor function in patients with subacute stroke with moderate to severe motor involvement should be individually tailored according to functional CST status and BDNF genotype. [ABSTRACT FROM AUTHOR]