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The purpose of this research was to investigate the immediate and 3-week short-term effects of kinesio taping (KT) on balance and walking ability in patients with stroke during post-acute care (PAC). A randomized controlled trial was designed to compare the outcome. Twenty stroke patients were randomly allocated into the KT or control group. After the KT intervention, there was no significant improvements in KT group in either balance or walking ability. After 3-week physical therapy, there were significant improvements in berg balance scale (BBS), 10 meter test (10MWT) and 6-minute walk test (6MWT) in both groups ( p<0.05). However, no significant differences in BBS, 10MWT, 6MWT and functional ambulation category scale between groups was found ( p>0.05). The results of this research demonstrated that KT seems to have no immediate and short-term effects on balance, walking speed, cardiopulmonary endurance and walking ability of PAC stroke patients. [ABSTRACT FROM AUTHOR]

Background: Interventions provided after hip fracture surgery have been shown to reduce mortality and improve functional outcomes. While some systematic studies have evaluated the efficacy of post-surgery interventions, there lacks a systematically rigorous examination of all the post-surgery interventions which allows healthcare providers to easily identify post-operative interventions most pertinent to patient's recovery. Objectives: We aim to provide an overview of the available evidence on post-surgery interventions provided in the acute, subacute and community settings to improve outcomes for patients with hip fractures. Methods: We performed a systematic literature review guided by the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). We included articles that were (1) randomized controlled trials (RCTs), (2) involved post-surgery interventions that were conducted in the acute, subacute or community settings and (3) conducted among older patients above 65 years old with any type of non-pathological hip fracture that was surgically treated, and who were able to walk without assistance prior to the fracture. We excluded (1) non–English language articles, (2) abstract-only publications, (3) articles with only surgical interventions, (4) articles with interventions that commenced pre-surgery or immediately upon completion of surgery or blood transfusion, (5) animal studies. Due to the large number of RCTs identified, we only included "good quality" RCTs with Jadad score ≥ 3 for data extraction and synthesis. Results: Our literature search has identified 109 good quality RCTs on post-surgery interventions for patients with fragility hip fractures. Among the 109 RCTs, 63% of the identified RCTs (n = 69) were related to rehabilitation or medication/nutrition supplementation, with the remaining RCTs focusing on osteoporosis management, optimization of clinical management, prevention of venous thromboembolism, fall prevention, multidisciplinary approaches, discharge support, management of post-operative anemia as well as group learning and motivational interviewing. For the interventions conducted in inpatient and outpatient settings investigating medication/nutrition supplementation, all reported improvement in outcomes (ranging from reduced postoperative complications, reduced length of hospital stay, improved functional recovery, reduced mortality rate, improved bone mineral density and reduced falls), except for a study investigating anabolic steroids. RCTs involving post-discharge osteoporosis care management generally reported improved osteoporosis management except for a RCT investigating multidisciplinary post-fracture clinic led by geriatrician with physiotherapist and occupational therapist. The trials investigating group learning and motivational interviewing also reported positive outcome respectively. The other interventions yielded mixed results. The interventions in this review had minor or no side effects reported. Conclusions: The identified RCTs regarding post-surgery interventions were heterogeneous in terms of type of interventions, settings and outcome measures. Combining interventions across inpatient and outpatient settings may be able to achieve better outcomes such as improved physical function recovery and improved nutritional status recovery. For example, nutritional supplementation could be made available for patients who have undergone hip fracture surgery in the inpatient settings, followed by post-discharge outpatient osteoporosis care management. The findings from this review can aid in clinical practice by allowing formulation of thematic program with combination of interventions as part of bundled care to improve outcome for patients who have undergone hip fracture surgery. [ABSTRACT FROM AUTHOR]

Stroke is a leading cause of disability with limited effective interventions that improve recovery in the subacute phase. This protocol aims to evaluate the safety and efficacy of a non-invasive, extremely low-frequency, low-intensity, frequency-tuned electromagnetic field treatment [Electromagnetic Network Targeting Field (ENTF) therapy] in reducing disability and promoting recovery in people with subacute ischemic stroke (IS) with moderate-severe disability and upper extremity (UE) motor impairment. Following a sample-size adaptive design with a single interim analysis, at least 150 and up to 344 participants will be recruited to detect a 0.5-point (with a minimum of 0.33 points) difference on the modified Rankin Scale (mRS) between groups with 80% power at a 5% significance level. This ElectroMAGnetic field Ischemic stroke-Novel subacutE treatment (EMAGINE) trial is a multicenter, double-blind, randomized, sham-controlled, parallel two-arm study to be conducted at approximately 20 United States sites, and enroll participants with subacute IS and moderate-severe disability with UE motor impairment. Participants will be assigned to active (ENTF) or sham treatment, initiated 4-21 days after stroke onset. The intervention, applied to the central nervous system, is designed for suitability in multiple clinical settings and at home. Primary endpoint is change in mRS score from baseline to 90 days post-stroke. Secondary endpoints: change from baseline to 90 days post-stroke on the Fugl-Meyer Assessment - UE (lead secondary endpoint), Box and Block Test, 10-Meter Walk, and others, to be analyzed in a hierarchical manner. EMAGINE will evaluate whether ENTF therapy is safe and effective at reducing disability following subacute IS. [ABSTRACT FROM AUTHOR]

Background: The use of non-invasive positive pressure ventilation (NIPPV) in COVID-19 patients with hypoxaemia is still under debate. The aim was to evaluate the efficacy of NIPPV (CPAP, HELMET-CPAP or NIV) in COVID-19 patients treated in the dedicated COVID-19 Intermediate Care Unit of Coimbra Hospital and University Centre, Portugal, and to assess factors associated with NIPPV failure. Methods: Patients admitted from December 1st 2020 to February 28th 2021, treated with NIPPV due to COVID-19 were included. Failure was defined as orotracheal intubation (OTI) or death during hospital stay. Factors associated with NIPPV failure were included in a univariate binary logistic regression analysis; those with a significance level of p < 0.001 entered a multivariate logistic regression model. Results: A total of 163 patients were included, 64.4% were males (n = 105). The median age was 66 years (IQR 56–75). NIPPV failure was observed in 66 (40.5%) patients, 26 (39.4%) were intubated and 40 (60.6%) died during their hospital stay. The highest CRP (OR 1.164; 95%CI 1.036–1.308) and morphine use (OR 24.771; 95%CI 1.809–339.241) were identified as predictors of failure after applying multivariate logistic regression. Adherence to prone positioning (OR 0.109; 95%CI 0.017–0.700) and a higher value of the lowest platelet count during hospital stay (OR 0.977; 95%CI 0.960–0.994) were associated with a favorable outcome. Conclusions: NIPPV was successful in over half of patients. Highest CRP during hospital stay and morphine use were predictors of failure. Adherence to prone positioning and a higher value of the lowest platelet count during hospital stay were associated with a favourable outcome. [ABSTRACT FROM AUTHOR]

Background: Planning discharges from subacute care facilities is becoming increasingly complex due to an ageing population and a high demand on services. The use of non-standardised assessments to determine a patient's readiness for discharge places a heavy reliance on a clinician's judgement which can be influenced by system pressures, past experiences and team dynamics. The current literature focusses heavily on discharge-readiness from clinicians' perspectives and in the acute care setting. This paper aimed to explore the perceptions of discharge-readiness from the perspectives of key stakeholders in subacute care: inpatients, family members, clinicians and managers. Methods: A qualitative descriptive study was conducted, exploring the views of inpatients (n = 16), family members (n = 16), clinicians (n = 17) and managers (n = 12). Participants with cognitive deficits and those who did not speak English were excluded from this study. Semi-structured interviews and focus groups were conducted and audio-recorded. Following transcription, inductive thematic analysis was completed. Results: Participants identified that there are both patient-related and environmental factors that influence discharge-readiness. Patient-related factors discussed included continence, functional mobility, cognition, pain and medication management skills. Environmental factors centred around the discharge (home) environment, and were suggested to include a safe physical environment alongside a robust social environment which was suggested to assist to fill any gaps in functional capabilities (i.e. patient-related factors). Conclusions: These findings make a unique contribution to the literature by providing a thorough exploration of determining discharge-readiness as a combined narrative from the perspectives from key stakeholders. Findings from this qualitative study identified key personal and environmental factors influencing patients' discharge-readiness, which may allow health services to streamline the determination of discharge-readiness from subacute care. Understanding how these factors might be assessed within a discharge pathway warrants further attention. [ABSTRACT FROM AUTHOR]

The article describes the case of a comorbid older female with multiple myeloma and pathologic fracture, who begins a standard multi-drug regimen to explore the barriers and potential solutions of transitions of care (TOC) in a post-acute and long-term care (PALTC) environment. Topics include barriers and solutions to cancer care transitions in PALTC, reason for the differences in treatment decisions by oncologists, and important move to achieve patient-centered decisions for cancer management.

Subacute osteomyelitis is frequently encountered in children and adolescents, affecting epiphysis of long shaft of extremities. And the pathogenic bacteria are Staphylococcus aureus or Streptococcus. It often has an occult onset with mild and non-typical symptoms and signs. Parameters of laboratory examination are generally normal or slightly elevated. Therefore it is easily underdiagnosed and misdiagnosed so that treatment becomes delayed. Upon a definite diagnosis, conservative treatment with antibiotics, surgical curettage or the combination of the two is effective. Most patients have decent outcomes. This review summarized clinical epidemiological characteristics, clinical manifestations, proper managements and outcomes of subacute osteomyelitis to guide clinical practices. [ABSTRACT FROM AUTHOR]

Senior adults (>age 65) represent almost 20% of the population but account for 48% of hospital bed occupancy. In older adults, hospitalization often results in functional decline (i.e., iatrogenic disability) and, consequently, the loss of autonomy. Physical activity (PA) has been shown to counteract these declines effectively. Nevertheless, PA is not implemented in standard clinical practice. We previously showed that MATCH, a pragmatic, specific, adapted, and unsupervised PA program, was feasible and acceptable in a geriatric assessment unit (GAU) and a COVID-19 geriatric unit. This feasibility study aims to confirm that this tool could be implemented in other geriatric care programs, notably a geriatric rehabilitation unit (GRU) and a post-acute care unit (PACU), in order to reach the maximum number of older patients. Eligibility and consent were assessed by the physician for all the patients admitted to the three units (GAU, GRU, and PACU). The rehabilitation therapist taught each participant one of the five PA programs based on their mobility score on the decisional tree. Implementation (eligibility (%): patients eligible/number admitted and delay of implementation: number of days until prescription); feasibility (adherence (%): number sessions completed/number sessions prescribed and walking time (%): total walking time/time prescribed time); and acceptability (healthcare team (%): tool adequacy (yes/no) and patient: System Usability Scale questionnaire (SUS: x/100)) were evaluated and analyzed using a Kruskal–Wallis ANOVA or Fisher's exact test. Eligibility was different between the units (GRU = 32.5% vs. PACU = 26.6% vs. GAU = 56.0%; p < 0.001), but the time before implementation was similar (days: GRU = 5.91 vs. PACU = 5.88 vs. GAU = 4.78; p > 0.05). PA adherence (GRU = 83.5% vs. PACU = 71.9% vs. GAU = 74.3%) and walking time (100% in all units) were similar (p > 0.05). Patients (SUS: GRU = 74.6 vs. PACU = 77.2 vs. GAU = 77.2; p > 0.05) and clinicians (adequacy (yes; %): GRU = 78.3%; PACU = 76.0%; GAU = 72.2%; p > 0.05) found MATCH acceptable. Overall, MATCH was implementable, feasible, and acceptable in a GAU, GRU, and PACU. Randomized controlled trials are needed to confirm our results and evaluate the health benefits of MATCH compared with usual care. [ABSTRACT FROM AUTHOR]

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients' characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. Methods: A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl–Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0–66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether a simple endoscopic method was effective for the evacuation of traumatic subacute subdural hematomas. A total of 51 patients with subacute subdural hematomas requiring surgery were enrolled in this study. An endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed for 29 patients. The postoperative Glasgow Coma Scale scores improvement, surgery times, displacement of midline measurements, and intraoperative blood loss were recorded and analyzed for each patient. The average time from the initial incision to suture completion was 38.41 ± 6.97 minutes for the endoscopic surgery group and 74.66 ± 9.54 minutes for the open-surgery group (P < 0.01). The average total blood loss was 41.36 ± 10.82 ml for the endoscopic group and 250.00 ± 58.25 ml for the open-surgery group (P < 0.01). No postoperative bleeding occurred in either group. The midline displacement measurement showed significant improvement on the day after surgery, with 5.21 ± 1.98 mm in the study group versus 6.75 ± 1.37 mm in the control group (P < 0.01). At the 1-month follow-up appointment, the midline measurement was normal in both groups. Computed tomography scans revealed almost no residual hematomas, representing an average evacuation rate of 100% in both groups. The average Glasgow Coma Scale scores improvement on the day after surgery were 1.77 ± 1.93 in the endoscopic surgery group and 1.66 ± 0.77 in the open-surgery group (P = 0.766). Endoscopic subacute subdural hematoma removal through a small bone window achieved satisfactory hematoma removal using a minimally invasive method when compared with an open-surgery method. [ABSTRACT FROM AUTHOR]

Objective: Inter‐hospital transfers are increasingly common due to the regionalisation of healthcare, but are associated with patient discomfort, high costs and adverse events. The aim of the present study was to evaluate the effectiveness of a trauma outreach service for preventing inter‐hospital transfers to a major trauma centre. Methods: This was an observational pre‐ and post‐intervention study over a 12‐month period from 1 October 2020 to 30 September 2021. Eligible patients sustained a fall at Caulfield Hospital, a subacute care hospital specialising in community services, rehabilitation, geriatric medicine and aged mental health. The intervention was delivery of site‐specific education at Caulfield Hospital and a trauma outreach service by specialist trauma clinicians at The Alfred Hospital who provided remote assessment, assisted with clinical management decisions and advised on appropriateness of transfer. Results: The present study included 160 patients in the pre‐intervention phase and 203 after the intervention. The primary outcome of transfer occurred in 19 (11.9%) patients in the pre‐intervention phase and 4 (2.0%) in the post‐intervention phase (P < 0.001). In the subgroup of patients without pelvis or long bone fractures, pre‐intervention transfer occurred for 17 (10.9%) patients and post‐intervention transfer occurred for 4 (2.0%) patients (P < 0.001). CT imaging was performed for 54 (33.8%) patients in the pre‐intervention and 45 (22.2%) patients in the post‐intervention group (P = 0.014). Conclusions: Telehealth consultation with a trauma specialist was associated with significant reduction of inter‐hospital transfers, and significant reduction of CT imaging. This supports continuation of the service with scope for expansion and evaluation of patient‐centred outcomes. Inter‐hospital transfers are increasingly common due to the regionalisation of healthcare. The aim of the present study was to evaluate the effectiveness of a quality improvement initiative comprising a site‐specific education package and trauma outreach service for preventing inter‐hospital transfers to a major trauma centre. We demonstrated significantly lower inter‐hospital transfer rates after the introduction of a pathway involving remote consultation with a trauma outreach service. [ABSTRACT FROM AUTHOR]

Background: Skilled nursing rehabilitative care plays a critical role in older adults' functional recovery impacting post‐discharge outcomes. Variations across post‐acute rehabilitative care services and patient outcomes indicate a need to improve rehabilitative care in this setting. We adapted a successful outpatient care program (Live Long Walk Strong‐LLWS) to address this need in post‐acute care settings within the Veterans Health Administration. LLWS differs from standard PT care by treating impairments linked to functional decline that are not traditionally targeted by standard care, providing formalized coaching to optimize behavior change, and providing post‐discharge case management to optimize long‐term outcomes. The purpose was to adapt, refine and implement the LLWS program for the Community Living Center (CLC), determine its acceptability and feasibility, and evaluate its preliminary effectiveness among older adults. Methods: The design of the program was adapted from the original outpatient LLWS program to the CLC setting through quality improvement methods and the Replicating Effective Programs (REP) framework. Primary outcomes included measures of feasibility and acceptability of >80% enrollment and completion of sessions as well as preliminary effectiveness using performance‐based and patient‐reported measures of function including the Short Physical Performance Battery (SPPB), AM‐PAC, a Global Rating of Change questionnaire, and a satisfaction survey. Results: After 18 months, 51 Veterans had enrolled in the LLWS program, with 94.1% maintaining enrollment. We observed >80% completion of the inpatient and home follow‐up sessions. Most patients were highly satisfied with care. Improvements in the SPPB (2.3 (SD 2.2) points), gait speed (0.17 (0.14) m/s) and the AM‐PAC (6.5 (SD 5.7)) surpassed clinically meaningful thresholds. Conclusions: This novel care program is feasible and acceptable to Veterans, demonstrating preliminary effectiveness with improving functional outcomes. Future research is needed to further examine the program's impact on other important outcomes relative to standard modes of care. [ABSTRACT FROM AUTHOR]

No single tool is able to distinguish fallers from non-fallers. The aim of this study was to detect subacute stroke inpatients at higher risk for falls, predictors for the number of falls and near falls and the impact of these incidents on functional outcome. An observational prospective cohort study comparing clinical differences between non-fallers, onetime and repeat fallers. Bivariate and multivariate Poisson regression analyses with length of stay as an offset variable were conducted. Fallers had mostly intermediate level of impairment and disability (NIHSS, FIM, mRS, the ICF minimal generic data set). The onetime fallers who were oldest, most disabled and most often institutionalised achieved the same functional improvement as the non-fallers, however, after significantly longer inpatient rehabilitation. The repeat fallers who were youngest and had the longest rehabilitation in-stay, achieved equal functioning as the non-fallers having faster motor gain and the greatest overall functional improvement compared to the other two subgroups. Right hemispheric stroke, previous myocardial infarction and shorter time from stroke onset were independent predictors for the number of incidents. In the future, larger studies are recommended to investigate fall rate and different severities of incidents, falls and near falls separately. [ABSTRACT FROM AUTHOR]

Acute flaccid myelitis (AFM) is a "polio-like" neurologic disorder of the spinal cord gray matter characterized by asymmetric, flaccid limb weakness of rapid onset following prodromal viral illness. It has affected the pediatric population of the United States since 2014, but there is a paucity of literature describing the post-acute comprehensive rehabilitation management that maximizes functional outcomes for patients. This case series attempts to mitigate this by describing the complete acute and post-acute care course of six children diagnosed with AFM in Western Pennsylvania. It is critical that pediatric rehabilitation medicine providers be knowledgeable about the complex medical and rehabilitation management for patients with AFM. [ABSTRACT FROM AUTHOR]

Medicare Advantage (MA) plans, which accounted for 45 percent of total Medicare enrollment in 2022, are incentivized to minimize spending on low-value services. Prior research indicates that MA plan enrollment is associated with reduced postacute care use without adverse impacts on patient outcomes. However, it is unclear whether a rising MA enrollment level is associated with a change in postacute care use in traditional Medicare, especially given growing participation in traditional Medicare Alternative Payment Models that have been found to be associated with lower postacute care spending. We hypothesize that market-level MA expansion is associated with reduced postacute care use among traditional Medicare beneficiaries--a "spillover" effect of providers modifying their practice patterns in response to MA plans' incentives. We found increased MA market penetration associated with reduced postacute care use among traditional Medicare beneficiaries, without a corresponding increase in hospital readmissions. This association was generally stronger in markets with a greater share of traditional Medicare beneficiaries attributed to accountable care organizations, suggesting that policy makers should account for MA penetration when evaluating potential savings in Alternative Payment Models within traditional Medicare. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the risk of symptomatic venous thromboembolism (VTE) recurrence at 3 months in relation to treatment duration, according to baseline risk factor profiles, in patients with superficial vein thrombosis (SVT) treated with intermediate dose of tinzaparin. Methods: We performed a pooled analysis on individual data from two prospective studies designed to assess the efficacy and safety of tinzaparin in intermediate dose (131 IU/kg) in patients with SVT. Treatment duration was at the treating physician's discretion. All patients were followed up for at least 3 months. Results: A total of 956 patients (65% female, mean age 58.7 ± 13.7 years) were included. The median treatment duration was 30 days (range, 3–200 days). History of deep vein thrombosis (DVT), location of SVT above the knee, and palpable induration were the only independent factors associated with prolonged treatment duration. During follow-up, 95.9% of patients were event free. Outcomes-related adverse events occurred in 39 (4.1%) patients and their median duration of treatment was 33 days (range, 7–200 days). Recurrent VTE events occurred in 33 patients, including 22 cases of SVT recurrence, 8 cases of DVT, and 1 case of pulmonary embolism. The median time to the event was 29 (6–113) days. Recurrent thromboembolic events were not related to treatment duration as occurred in 17 patients (51.5%) treated up to 30 days and in 16 patients (48.8%) received prolong treatment (p =.46). Length of thrombus at the index event was significantly associated with higher risk for VTE recurrence. Conclusions: Intermediate dose of tinzaparin for 30 days is an effective and safe treatment for SVT. The risk of recurrent VTE events may be higher in patients with greater amount of thrombus at index event. [ABSTRACT FROM AUTHOR]

Background: Although Monteggia fracture dislocation is a rare injury, representing less than 1% of pediatric forearm fractures, missed Monteggia injuries are common, representing up to 50% of the acute injury. Both the acute and the chronic Monteggia injuries have different treatment protocols. There is a gray zone between the acute and the chronic Monteggia fracture dislocation, which represents the period after 2 weeks of injury until the ulnar fracture union. Objective: This study aimed to identify the treatment protocol for this gray zone between the acute and the chronic Monteggia fracture dislocation. Patients and Methods: Sixteen subacute Monteggia fracture dislocation patients (10 boys and 6 girls) underwent either closed or open reduction of the ulnar fracture with internal fixation. The patient's mean age was 9 years. Inclusion criteria conditioned a patient with Monteggia fracture dislocation after two weeks of the injury and before the ulnar fracture union. Results: By the end of the follow-up, all patients resumed full elbow range of motion with no elbow pain or deformity. All radiological parameters, including the radiocapitellar line and the ulnar bow lines, were normal at the end of the follow-up, with no redislocation of the radial head. Conclusions: Unlike the acute injury, there is no role for conservative treatment in the subacute Monteggia fracture dislocation. And contrary to chronic Monteggia, all patients didn't need open reduction of the radial head. Level of evidence: level IV. [ABSTRACT FROM AUTHOR]

Background: Skilled nursing facilities' (SNFs) ability to provide optimal post-acute care depends on effective receipt of information from hospitals ("information continuity"). Little is known about how SNFs perceive information continuity and how it may relate to upstream information sharing processes, organizational context, and downstream outcomes. Purpose: First, this study aims to identify how SNF perceptions of information continuity may be shaped by hospital information sharing practices, including measures of completeness, timeliness, and usability, as well as characteristics of the transitional care environment (i.e., integrated care relationships and/or consistency of information sharing practices across different hospital partners). Second, we analyze which of these characteristics are associated with quality of transitional care (measured by 30-day readmissions). Approach: A cross-sectional analysis of nationally representative SNF survey (N = 212) linked to Medicare claims was performed. Results: SNF perceptions of information continuity are strongly and positively associated with hospital information sharing practices. Adjusting for actual information sharing practices, SNFs that experienced discordance across hospitals reported lower perceptions of continuity (β = −0.73, p =.022); evidence of stronger relationships with a given hospital partner appears to help facilitate resources and communication that helps to close this gap. Perceptions of information continuity, more so than the upstream information sharing processes reported, exhibited a more reliable and significant association with rates of readmissions as an indicator of transitional care quality. Conclusion: SNF perceptions of information continuity are strongly associated with patient outcomes and are reflective of both hospital information sharing practices as well as characteristics of the transitional care environment that can mitigate or amplify the cognitive and administration challenge of their work. Practice Implications: Improving transitional care quality requires that hospitals improve information sharing behaviors but also invest in capacity for learning and process improvement in the SNF environment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and pain fluctuations of methylcobalamin in combination with lidocaine local injection treatment for subacute herpetic neuralgia (SHN). Methods: Seventy-nine women (60.4 ± 2.7 years) with thoracic SHN were enrolled and randomized to receive a combination of methylcobalamin and lidocaine local injection (MI, N=40), or a combination of lidocaine patch 5% and oral methylcobalamin (PO, N=39) for four weeks. Repeated-measures analyses of variance were used to evaluate the effect on pain levels. Generalized estimation equations were used to analyze the cause-effect relationship between pain fluctuations and influencing factors. Results: At the treatment endpoint, the group, treatment time, and group interacted with treatment time effects of the pain scores and area were statistically significant (P< 0.001), The pain scores were 2.9 ± 0.9 (MI) and 4.3 ± 1.5 (PO). 80.00% (MI) or 28.21% (PO) of patients had pain scores ≤  3, the odds ratio was 2.84 (95% CI: 1.68 to 4.79). The incidence of postherpetic neuralgia was 5.0% (2/40) at 3 months. Pain fluctuated repeatedly during treatment. The pain fluctuation increased from 8.75 log folds in the afternoon, to 79.85 log folds at night. With the ADLs level increasing from 1 to 3, the pain fluctuated from 4.28 to 17.70 log folds. Allodynia, itching, sleep quality, and ADLs were the significant influencing factors (P< 0.05). Conclusion: This study validated the efficacy of methylcobalamin combined with lidocaine for SHN, and confirmed that pain levels in patients with SHN had an obvious circadian rhythm. ADLs were an important cause of pain fluctuations. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is the leading cause of hospitalization among older adults in the United States and results in high rates of post-acute care (PAC) utilization. Federal policies have focused on shifting PAC to less intensive settings and reducing length of stay to lower spending. This study evaluates the impact of policy changes on PAC use among Medicare beneficiaries hospitalized with HF between 2008 and 2015 by (1) characterizing trends in PAC use and cost and (2) evaluating changes in readmission, mortality, and days in the community, overall and by frailty. Methods: Annual cross-section prospective cohorts of all HF admissions between 1/1/2008 and 9/30/2015 among a 20% random sample of all Medicare Fee-for-Service beneficiaries (n = 718,737). The Claims-based Frailty Index (CFI) was used to classify frailty status. Multivariable regression models were used to evaluate trends in first discharge location, readmissions, mortality, days alive in the community, and costs; overall and by frailty status. Results: Frailty was prevalent among HF patients: 54.1% were prefrail, 37.0% mildly frail, and 6.9% moderate to severely frail. Between 2008 and 2015, almost 4% more HF beneficiaries received PAC, with most of the increase concentrated in skilled nursing facilities (SNF) (+2.3%) and home health agencies (HHA) (+1.1%), and PAC cost increased by $123 (3.5%). Over the 180-days follow-up after hospitalization, hospital readmissions decreased significantly (-3.4% at 30-day; -6.3% at 180-day), days alive in the community increased (+1.5), and 180-day Medicare costs declined $2948 (-18.7%) without negative impact in mortality (except a minor increase in the pre-frail group). Gains were greatest among the frailest patients. Conclusions: Medicare beneficiaries hospitalized with HF spent more time in the community and experienced lower rehospitalization rates at lower cost without significant increases in mortality. However, important opportunities remain to optimize care for frail older adults hospitalized with HF. [ABSTRACT FROM AUTHOR]

The article presents a study which investigated differences in post-acute care admissions before and during the COVID-19 pandemic in Sao Paulo, Brazil. Topics discussed include differences in admissions according to the study period, impact of the COVID-19 pandemic on the incipient post-acute care setting in Brazil, and characteristics and outcomes of post-acute care admissions before and during the pandemic.

Introduction: Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive‐behavioral therapy (CBT) may be useful in the post‐acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high‐quality care for AN, including in the post‐acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT‐based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. Method: In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT‐based mobile intervention plus treatment as usual (TAU), a CBT‐based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within‐mobile intervention predictors and moderators of outcome. Discussion: Ultimately, this research may lead to increased access to evidence‐based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. Public Significance: Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence‐based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder. [ABSTRACT FROM AUTHOR]

In stroke rehabilitation, measurement tools measuring self-efficacy with sound psychometric properties are needed. The Stroke Self-Efficacy Questionnaire (SSEQ) has recently been translated and validated into a Danish version (SSEQ–DK). To evaluate the test–retest reliability of the SSEQ-DK. Fifty people with stroke ≥ 18 years in the sub-acute and chronic phase were included from February 2019 to August 2020. The SSEQ-DK was completed twice; on day 1 and day 7–14. Test–retest reliability of the single items was assessed using weighted Cohen's kappa and percentage agreement. The activity and self-management scales were assessed by the intraclass correlation coefficient (ICC). Measurement error was assessed by calculating the Smallest Detectable Change (SDC) based on the standard error of measurement. Overall, kappa values showed fair to substantial test–retest reliability of the single items. However, several kappa values were missing as the statistical prerequisites were not present. The percentage agreement ranged from 78% to 94%. Based on the reported confidence interval of the estimated intraclass correlation coefficient, the test–retest reliability of the activity and self-management scales was poor to excellent in all analysis. Ceiling effects appeared in the single items. Conversely, no floor effect was seen. The SSEQ-DK showed good test–retest reliability of the single items based on agreement among a population with stroke in the subacute and chronic phase. Broad ICC confidence intervals bar any firm conclusions concerning the test–retest reliability of the activity and self-management scales. ClinicalTrials.gov NCT03183960. Reg. 15 June 2017. [ABSTRACT FROM AUTHOR]

Objectives: The FRAIL-NH scale was developed to identify frailty status in nursing home residents. The purpose of this study was to examine the utility of the FRAIL-NH scale for predicting nursing home admission among patients in post-acute care settings. Design/Setting/Participants: This single-center, prospective, observational cohort study included participants aged 65 years or older who were admitted to a community-based integrated care ward (CICW) between July 2015 and November 2020. Measurements: Using the CICW database, we retrospectively classified participants as robust, prefrail, or frail based on the FRAIL-NH scale the score by identifying variables from our database that were most representative of each component. The following data were collected: examination findings, CICW admission and discharge information, length of CICW stay, and nursing home admission. The participants were divided into two groups based on whether or not they were admitted to a nursing home after CICW discharge. The hazard ratios (HRs) and 95% confidence intervals (CIs) for nursing home admission were calculated according to the FRAIL-NH categories using the Cox proportional hazards models with reference to the robust group. In the multivariate adjusted model, we adjusted for age, sex, nutritional status, cognitive function, living status, and economic status. Results: Data of 550 older adults were analyzed, of which 118 were admitted and 432 were not admitted to a nursing home. The frail group had a higher risk of nursing home admission (HR, 2.22; 95% CI 1.32–3.76) than the robust group. Conclusions: This study showed that the FRAIL-NH scale was beneficial for predicting nursing home admission among older adults in the post-acute care setting. Thus, assessment using the FRAIL-NH scale may help to consider preparation and support for life after discharge. [ABSTRACT FROM AUTHOR]

Aim: Describe the strategy, efficacy and preferred mechanisms of training used to rapidly upskill intermediate care nursing staff to provide critical care during the COVID‐19 pandemic. Design: Descriptive study. Methods: The strategy used from March through December 2020 to upskill nurses in an intermediate care unit to administer critical care upon rapid conversion of the intermediate care unit to an intensive care unit for coronavirus disease 2019 is described. Training and education included paired staffing models, interdisciplinary education, skills days and self‐directed learning. Nurses engaged in this upskilling process were surveyed to evaluate their confidence in new critical care competencies and educational preferences. Results: Of 38 intermediate care nurses, 35 completed training and began independent intensive care practice. Nursing confidence in critical care competencies increased steadily. Nurses demonstrated the greatest preference for peer education models, particularly those incorporating the hospital's pre‐existing medical intensive care nurses. Patient and Public Contributions: No patient or public contributions were made to this manuscript. [ABSTRACT FROM AUTHOR]

ObjectivesLong-term acute care (LTAC) hospitals provide extended complex post-acute care to more than 120 000 Medicare beneficiaries annually, with the goal of helping patients to regain independence and recover. Because little is known about patients' long-term outcomes, we sought to examine the clinical course after LTAC admission.DesignNationally representative 5-year cohort study using 5% Medicare data from 2009 to 2013.SettingLTAC hospitals.ParticipantsHospitalized Medicare fee-for-service beneficiaries 65 years of age or older who were transferred to an LTAC hospital.MeasurementsMortality, recovery (defined as achieving 60 consecutive days alive without inpatient care), time spent in an inpatient facility following LTAC hospital admission, receipt of an artificial life-prolonging procedure (feeding tube, tracheostomy, hemodialysis), and palliative care physician consultation.ResultsOf 14 072 hospitalized older adults transferred to an LTAC hospital, median survival was 8.3 months, and 1- and 5-year survival rates were 45% and 18%, respectively. Following LTAC admission, 53% never achieved a 60-day recovery. The median time of their remaining life a patient spent as an inpatient after LTAC admission was 65.6% (interquartile range = 21.4%-100%). More than one-third (36.9%) died in an inpatient setting, never returning home after the LTAC admission. During the preceding hospitalization and index LTAC admission, 30.9% received an artificial life-prolonging procedure, and 1% had a palliative care physician consultation.ConclusionHospitalized older adults transferred to LTAC hospitals have poor survival, spend most of their remaining life as an inpatient, and frequently undergo life-prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and prioritize healthcare needs for hospitalized older adults admitted to LTAC hospitals. Given the exceedingly low rates of palliative care consultations, future research is needed to examine unmet palliative care needs in this population. J Am Geriatr Soc 67:2282-2288, 2019.

BackgroundUnderstanding and addressing racial and ethnic disparities in the quality of post-acute care in skilled nursing facilities is an important health policy issue, particularly as the Medicare program initiates value-based payments for these institutions.MethodsOur final cohort included 649,187 Medicare beneficiaries in either the fee-for-service or Medicare Advantage programs, who were 65 and older and were admitted to a skilled nursing facility following an acute hospital stay, from 8,375 skilled nursing facilities. We examined the quality of care in skilled nursing facilities that disproportionately serve minority patients compared to non-Hispanic whites. Three measures, all calculated at the level of the facility, were used to assess quality of care in skilled nursing facilities: (a) 30-day rehospitalization rate; (b) successful discharge from the facility to the community; and (c) Medicare five-star quality ratings.ResultsWe found that African American post-acute patients are highly concentrated in a small number of institutions, with 28% of facilities accounting for 80% of all post-acute admissions for African American patients. Similarly, just 20% of facilities accounted for 80% of all admissions for Hispanics. Skilled nursing facilities with higher fractions of African American patients had worse performance for three publicly reported quality measures: rehospitalization, successful discharge to the community, and the star rating indicator.ConclusionsEfforts to address disparities should focus attention on institutions that disproportionately serve minority patients and monitor unintended consequences of value-based payments to skilled nursing facilities.

Background and purpose: The aim of this study was to assess the neurological complications of SARS‐CoV‐2 infection and compare phenotypes and outcomes in infected patients with and without selected neurological manifestations. Methods: The data source was a registry established by the European Academy of Neurology during the first wave of the COVID‐19 pandemic. Neurologists collected data on patients with COVID‐19 seen as in‐ and outpatients and in emergency rooms in 23 European and seven non‐European countries. Prospective and retrospective data included patient demographics, lifestyle habits, comorbidities, main COVID‐19 complications, hospital and intensive care unit admissions, diagnostic tests, and outcome. Acute/subacute selected neurological manifestations in patients with COVID‐19 were analysed, comparing individuals with and without each condition for several risk factors. Results: By July 31, 2021, 1523 patients (758 men, 756 women, and nine intersex/unknown, aged 16–101 years) were registered. Neurological manifestations were diagnosed in 1213 infected patients (79.6%). At study entry, 978 patients (64.2%) had one or more chronic general or neurological comorbidities. Predominant acute/subacute neurological manifestations were cognitive dysfunction (N = 449, 29.5%), stroke (N = 392, 25.7%), sleep–wake disturbances (N = 250, 16.4%), dysautonomia (N = 224, 14.7%), peripheral neuropathy (N = 145, 9.5%), movement disorders (N = 142, 9.3%), ataxia (N = 134, 8.8%), and seizures (N = 126, 8.3%). These manifestations tended to differ with regard to age, general and neurological comorbidities, infection severity and non‐neurological manifestations, extent of association with other acute/subacute neurological manifestations, and outcome. Conclusions: Patients with COVID‐19 and neurological manifestations present with distinct phenotypes. Differences in age, general and neurological comorbidities, and infection severity characterize the various neurological manifestations of COVID‐19. [ABSTRACT FROM AUTHOR]

This study aims to explore health professionals' perceived benefits of implementing Communication Partner Training (CPT) using Supported Conversation for Adults with Aphasia (SCA™) in a subacute rehabilitation setting with patients in post-traumatic confusional state (PTCS) after TBI. The study was conducted in a clinical setting using a pre-post questionnaire design to explore change. One hundred and four interdisciplinary clinicians attended CPT in the SCA™ method and subsequent implementation support. Participants completed a questionnaire with both quantitative and qualitative questions before and after the training and implementation period. Data were analyzed using descriptive and inferential statistics and qualitative content analysis. Participants' perceived confidence and self-assessed ability to communicate with patients in PTCS significantly increased after CPT (p = 0.006). While participants still experienced communication challenges, they reported using CPT-related tools and strategies in their interactions. Participants found they could apply strategies to improve patients' comprehension of information and to confirm their understanding of patients' communication. However, using strategies to enhance patients' expressive abilities was perceived as more challenging. Training health professionals in CPT increase their confidence in managing communication with patients in PTCS. Further research is needed to evaluate the efficacy of CPT within a more rigorous research design. [ABSTRACT FROM AUTHOR]

Burns in children are unfortunately common. They are most common in preschool children with almost two-thirds occurring in children under 5 years of age. Management of severe burns is truly interdisciplinary, with children often requiring acute medical, nursing and surgical care. Optimal care requires treatment in primary, secondary and tertiary care settings and involves primary care health professionals, emergency services, emergency department health care professionals, paediatricians and paediatric surgical teams. This short review outlines the epidemiology and discusses the management priorities in the acute and sub-acute and chronic phases. [ABSTRACT FROM AUTHOR]

Background: In Italy, there is scant evidence on the impact of Community Hospitals (CHs) on clinical outcomes. Aims: To assess the effectiveness of CHs versus long-term care hospital or inpatient rehabilitation facilities on mortality, re-admission, institutionalization, and activation of a home care programme in the Emilia-Romagna Region (ERR-Italy) after acute hospitalisation. Methods: We implemented a cohort study drawing upon the ERR Administrative Healthcare Database System and including hospital episodes of ERR residents subject ≥ 65 years, discharged from a public or private hospital with a medical diagnosis to a CH or to usual care between 2017 and 2019. To control for confounding, we applied a propensity score matching. Results: Patients transferred to CHs had a significantly lower risk of dying but an increased risk of being readmitted to community or acute hospital within 30/90 days from discharge. The hazard of institutionalisation within 30/90 days was significantly lower in the whole population of the CH exposed group but not among patients with cardiac or respiratory chronic diseases or diabetes. The activation of a home care program within 90 days was slightly higher for those who were transferred to a CH. Discussion: The findings of our study show mixed effects on outcomes of patients transferred to CHs compared to those who followed the post-acute usual care and should be taken with cautious as could be affected by the so-called 'confounding by indication'. Conclusions: The study contributes to the intermediate care available evidence from a region with a well-established care provision through CHs. [ABSTRACT FROM AUTHOR]

Aims: The Cognitive Performance Scale (CPS), a minimum data set instrument of the interRAI, was initially designed to evaluate cognition in residential care and has demonstrated strong diagnostic accuracy. In this study, we evaluated the diagnostic accuracy and validity of the CPS in the post‐acute care setting among post‐stroke patients hospitalized in rehabilitation wards. Design: Mixed methods. Methods: The observational study was conducted in rehabilitation wards. Diagnostic accuracy was used to explore the level of agreement between CPS and Montreal Cognitive Assessment (MoCA) in 321 inpatients (62.12 years; 68.2% male). Results: The diagnostic accuracy of the CPS was poor when MoCA was less than 24 as a gold standard, with an area under the curve of 0.69 (standard error 0.03, 95% confidence interval = 0.62–0.75). The CPS had a poor to moderate correlation with MoCA (rs = −.35). [ABSTRACT FROM AUTHOR]

Background: Most patients transported by Ontario paramedics to the emergency department have non-emergent conditions and may be more appropriately served by subacute community-based care centres. We sought to determine consensus on a set of patient characteristics that could be useful to classify retrospective emergency department visits that had a high probability of being primary care–like and potentially redirectable to a subacute care centre by paramedics. Methods: We conducted a modified Delphi study to assess expert consensus on characteristics of patients transported by paramedics to the emergency department from August to October 2021. An expert Delphi committee was constructed of emergency and family physicians in Ontario using purposive sampling. Experts rated whether each characteristic was useful to be included in a classification to identify potentially redirectable visits retrospectively, as well as characteristic details (e.g., upper and lower bounds). Consensus was considered 75% agreement. Results: Sixteen experts participated in the study; the experts were mostly male (75%) and evenly divided between emergency and family medicine. After 2 rounds, consensus was achieved on 8 of 9 characteristics (89%). Four characteristics were determined as useful to classify potentially redirectable emergency department visits: age (81%), triage acuity (100%), specialist consult in the emergency department (94%) and emergency department visit outcome (81%). Specifications of each characteristic were refined as follows: young and middle-aged adults with a non-emergent triage acuity, did not receive a specialist physician consult in the emergency department and discharged from the emergency department. Interpretation: Strong consensus was achieved to specify a classification system for potentially redirectable emergency department visits. These results will be combined with knowledge of which subacute care centres could conduct the main physician interventions to retrospectively identify emergency department visits that could have been suitable for paramedic redirection for further research. Study registration: ID ISRCTN22901977. [ABSTRACT FROM AUTHOR]

Occlusion of femoro-popliteal bypass: treatment by percutaneous mechanical rotational thrombectomy using Rotarex® Illustrated with two case reports, we have reviewed the contemporary clinical data regarding the safety, the efficacy, and the outcomes of percutaneous mechanical rotational thrombectomy (PMT) therapy using Rotarex® catheter in acute and subacute femoro-popliteal bypass thrombosis. This approach has various advantages: minimally invasive, easy to use, short procedural time, reduced thrombus burden, low complication rate, no vessel wall damage, successful in restoring vessel patency, unmask underlying lesions, short hospital stay, and no intensive care unit stay. PMT with the Rotarex® system appears to be an effective alternative in the treatment of acute and subacute femoro-popliteal bypass occlusions compared to established therapies, such as vascular surgery and local lysis. [ABSTRACT FROM AUTHOR]

Background: Trauma-specific nursing units are integral to providing quality trauma care. Yet, little has been published on intermediate care units for the trauma population. Objective: This article aims to describe one trauma center's journey to develop and implement a trauma intermediate care unit. Methods: The need for a trauma intermediate care unit was identified during the review of patient care at a Level II trauma center. An interdisciplinary team was created and met weekly for 6 months to plan the implementation of a trauma intermediate care unit. Education plans, training, equipment procurement, and staffing were evaluated throughout the process. Results: Positive results were noted from the implementation of the intermediate care unit through the first year following implementation. The average length of stay for patients in the surgical trauma intensive care unit was reduced, resulting in cost savings for the organization. In addition, this collaborative work positively impacted patient safety, staff engagement, and finances. Conclusion: With leadership support, the proper key stakeholders, clear deliverables, and a well-defined development plan, the implementation of this intermediate care unit was successful. [ABSTRACT FROM AUTHOR]

• Nurse documentation of symptoms of delirium superimposed on dementia and subsequent interventions is poorly described in post-acute care. • Documentation of symptoms occurred in over ¾ of the sample, while documentation of interventions remained low. • We need to think about creative ways to improve nurse documentation of symptoms and intervention's so that interdisciplinary communication, care, and patient outcomes are positively impacted. Delirium superimposed on dementia (DSD) is common in older adults being discharged to post-acute care settings (PAC). Nurse documentation remains poorly understood. Aims were to describe nurse documentation and to determine associations in a secondary data analysis of a large, single-blinded randomized controlled trial (Recreational Stimulation For Elders As A Vehicle To Resolve DSD (Reserve For DSD). Just under 75% of the sample had at least one symptom of delirium documented by the nursing staff, while 25.9% had none despite being CAM positive by expert adjudication. Only 32% had an intervention documented. Number of documented interventions were significantly associated with number of documented symptoms. There is a need for research and innovation related to nurse documentation and communication of DSD symptoms and interventions in an efficient and accurate manner to impact care for vulnerable older adults in these settings. [ABSTRACT FROM AUTHOR]

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Background Following a massive outbreak of the coronavirus disease 2019 (COVID-19) pandemic, a significant number of survivors are still suffering from residual symptoms and complications. We designed a preliminary study to evaluate such symptom spectra in COVID-19 patients who had been discharged from the hospital. Methods A telephone interview was conducted with 100-randomly chosen hospital-discharged COVID-19 survivors from the electronic patient record. The interview structure and method were developed by a panel of experts. A specially trained group conducted the interviews and data collection. The statistical analysis was performed in accordance with the data type (continuous and categorical). Group comparisons were also done between intensive care unit (ICU) versus general ward admission, and patients discharged between 3 and 12 weeks versus more than 12 weeks. Additionally, world clouds were used for better visualization of various prevalent symptoms. Results Eighty-two participants were finally included for interview after preliminary screening. Fifty-three patients (64.6%) were male participants; 74.4% had at least one symptom. In general, fatigue, cough, insomnia, and shortness of breath were the most common persistent symptoms. Symptoms were more prevalent among the patients discharged from ICU compared with those discharged from the general ward. Cough, loss of appetite, depression, and incoherence were more common in patients after 12 weeks of hospital discharge. Conclusion There is a wide range of persistent symptoms in the COVID-19 survivors who have been discharged from the hospital. Some symptoms arise or persisted even after 12 weeks. Based on the study results, available literature, and expert consensus, an assessment form has been developed that could be used for further research and clinical assessment of similar problems. Large-scale epidemiological study (longitudinal and cross-sectional) is needed to understand the nature and prevalence of the postacute phase of COVID-19 at the country level. The results of this study could inform the stakeholders and policymakers for taking necessary steps toward a further decision. [ABSTRACT FROM AUTHOR]

Context: Despite the strong emphasis on prevention in social care policy, there is a lack of evidence on the effectiveness of preventive social care interventions to delay escalation of intensive care needs. Objective(s): We reviewed the literature relating to the role of Adult Social Care to prevent escalation of care needs. We aimed to identify mechanisms in service delivery that prevent development of long-term care needs. Method(s): We used the PRISMA-ScR framework to review papers reporting the (cost) effectiveness of preventative services. Findings were qualitatively synthesised using elements of realist synthesis. Findings: Thirty-one papers were included covering: integrated care, intermediate care, rehabilitation, post-discharge services, community-based care, and domiciliary care. Overall, we found few studies with conclusive results to inform policy and practice. Moreover, the evidence was mostly concerned with the impact of social care on health care utilisation, with relatively few studies addressing the impact on social care utilisation. There was some preliminary evidence for the effectiveness of multi-faceted support set within the community, and improvements were observed for patients' Quality of Life. Limitations: The variety of papers we included reflects the complexity of the social care landscape but prevents robust assessment of the impact of services to delay advancing care needs. Implications: Greater investment in research in this field will help policy makers and families target scarce resources and invest in the most effective prevention services. We emphasise the impact of prevention services can take several years to realise, which must be reflected in research design and social care funding. [ABSTRACT FROM AUTHOR]

Objective: Alternatives to conventional acute hospitalizations have been particularly useful during the COVID-19 pandemic. However, little is known on the management and outcomes of COVID-19 in older patient admitted to non-acute settings. The main aim of this study was to determine the effect of geriatrics syndromes on functional outcomes in older COVID-19 patients cared in sub-acute units. Methods: Prospective multicenter observational cohort study of patients aged 65 years and older with COVID-19, admitted to sub-acute units in Italy and Spain. Multivariable logistic regression models were used to test the association between geriatric syndromes and other clinical variables, and the functional status at discharge, defined by a Barthel Index > = 80. Results: A total of 158 patients were included in the study with a median age of 82 [Interquartile Range 81, 83]; of these 102 (65%) patients had a Barthel Index ≥ 80 at discharge. In the main multivariable logistic regression model a higher severity of frailty-measured with the Clinical Frailty Scale—(OR 0.30; CI 0.18–0.47), and the presence of delirium (OR 0.04; CI 0.00–0.35) at admission were associated with lower odds of a higher functional status at discharge. Other variables associated with lower functional status were female gender (OR 0.36; CI 0.13–0.96), and a higher number of comorbidities (OR 0.48; CI 0.26–0.82). Conclusion: The study reports a relatively high prevalence of functional recovery for older COVID-19 patients admitted to sub-acute units. Additionally, it underlines the importance of targeting geriatrics syndromes, in particular frailty and delirium, for their possible effects on functional recovery. [ABSTRACT FROM AUTHOR]

People with communication disability after stroke need interventions to optimise healthcare communication and rehabilitation outcomes. Current evidence syntheses do not adequately inform the management of communication disability during the first 90 days post-stroke. To explore the scope of literature for the management of communication disability in the first 90 days after stroke. A scoping review was conducted using a systematic keyword search of six databases. A descriptive synthesis was generated using communication-related domains related to the biopsychosocial framework of the International Classification of Functioning, Disability, and Health (ICF). A total of 129 studies met eligibility criteria. Aphasia was the most frequently addressed communication disability after stroke (76/129 studies) with a paucity of evidence investigating other acquired neurogenic communication impairments. Management predominantly focused on communication-related: body functions and structures (62 studies) (e.g., linguistic-behavioural therapies), followed by environmental factors (39 studies) (e.g., communication partner training/support); activities and participation (15 studies) (e.g., augmentative and alternative communication); and personal factors (13 studies) (e.g., assessment of depression after aphasia). A coordinated, integrated approach to developing and testing acute and subacute interventions for all communication disabilities across all communication-related domains is required. Interdisciplinary stroke clinicians need to manage communication disabilities in the first 90 days after stroke to optimise healthcare communication and rehabilitation outcomes. There is some evidence to guide clinicians in aphasia management but less in other disabilities of speech and cognitive functioning. Most interventions to inform clinical practice address communication-related body functions and structures (e.g., linguistic and speech therapies). Clinicians need to address all domains and more evidence is needed to address environmental factors (e.g., communication support); activities and participation (e.g., person-centred goal setting); and personal factors (e.g., psychological care). [ABSTRACT FROM AUTHOR]

To investigate the sustainability of Robot-assisted upper limb therapy (RT-UL) as part of routine occupational therapy and physiotherapy clinical practice. Two separate audits, 12 months apart, of RT-UL computer data records were undertaken to determine sustainability in a subacute rehabilitation unit. Records of the two audits were compared in terms of the number of early subacute stroke survivors using RT-UL, the number of RT-UL sessions, duration of RT-UL sessions, and disciplines prescribing RT-UL. During Audit 1 58% (n = 18) of stroke survivors received RT-UL compared to 50% (n = 7) in Audit 2. The total number of RT-UL sessions reduced between audits (148 vs. 36 sessions) reflecting the overall reduction in admission rates for stroke survivors. There was no significant difference between audits in the average number of RT-UL sessions per patient (p = 0.203) nor the length of sessions (p = 0.762). Patients engaged in active therapy more than three-quarters of the time when on the robotic device. Physiotherapists were the primary prescribers of RT-UL when compared to occupational therapists. RT-UL was in continued and regular use with stroke survivors 2 years after initial implementation within an inpatient rehabilitation setting. RT-UL practice was intensive and used routinely with patients. RT-UL is a sustainable and intensive intervention for stroke survivors within an inpatient rehabilitative setting. The cost-benefits of RT-UL should be evaluated from the perspective of the whole rehabilitation service not just at an individual patient level. RT-UL may be considered a "bridging" form of UL practice for those with more limited active UL movement until there is sufficient UL movement and power for more complex real-world task-specific practice. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To assess the rate of occurrence of subacute Stent Thrombosis (SAT) after primary PCI in the patients presented with the acute coronary syndrome. Study Design: Retrospective crosssectional study. Place and Duration of Study: Tertiary Cardiac Care Center of Lahore Pakistan, from Jul 2019 to Jun 2021. Methodology: The retrospective demographical and angiographic data of the admitted patients who underwent PCI for ACS, was gathered from the Hospital Registry of a tertiary cardiac care center of Lahore. The sampling technique was nonprobability consecutive sampling, and all the data was analyzed using SPSS-20.0 and continuous data was presented as Mean±SD and frequencies and percentages for categorical variables. Chi square test (CI=95%, α=5%) was used to find the association of SAT with predisposing factors. pvalue <0.05 was taken as statistically significant. Results: Out of (n=551) patient underwent PPCI, the stent thrombosis was observed to occur in 29(5.2 %), among which 4.9 % were subacute stent thrombosis. The predisposing factors of subacute stent thrombosis were Diabetes Mellitus, ACS, smaller vessel size, presence of bifurcation lesion, under sizing of the stent and edge dissection and were in significant association with SAT (p<0.05). Conclusion: Our study reveals that subacute stent thrombosis is an event with a comparatively higher frequency in patients who go through primary PCI for acute coronary syndrome, demonstrating a frequency of 4.9% and a mortality rate of 74% within 30 days of the procedure. [ABSTRACT FROM AUTHOR]

Background In 2017, the agreement on an intermediate level of outpatient palliative care (BQKPMV) emerged. It is unclear what role BQKPMV plays in healthcare practice and what experiences family physicians have with the implementation. Methods In September 2021, all 5012 family physicians in Lower Saxony were invited to participate in an online or paper-based questionnaire survey on the implementation of BQKPMV. Data were analysed using descriptive statistics and frequency analyses. Results With 665 responses, a participation rate of 13 % was achieved. Data from 642 family physicians were included in the analysis. 13 % of the respondents (n = 84) are aware of BQKPMV. 71% of the participants with knowledge of BQKPMV (n = 58) have decided not to participate in the agreement. Thirty-eight of these family physicians justify this by saying that they consider the existing forms of outpatient palliative care to be sufficient. More than half of the participants see difficulties in the practical implementation. Conclusions The results of the survey of family physicians in Lower Saxony indicate that BQKPMV is rarely used in the clinical practice of the participants. Respondents see limitations in the feasibility of BQKPMV. Due to the rather low response rate and the regional connection, reliable nationwide conclusions about the reality of care can only be drawn to a limited extent. It is conceivable that, in addition to providing all family physicians with low-threshold information about BQKPMV, the framework conditions of BQKPMV need to be adjusted, e.g. in the areas of qualification requirements, remuneration and the distribution of tasks. Recommendations for optimising BQKPMV are developed in the overall project and enable a comprehensive evaluation of the implementation of this form of care. [ABSTRACT FROM AUTHOR]

Background: Thoracic endovascular aortic repair (TEVAR) can only promote 55-80% false lumen (FL) thrombosis when only the proximal primary tear is covered during the repair of type B aortic dissection (TBAD). This study evaluated the effectiveness and clinical outcome of tailored exclusion of the primary entry tear with TEVAR and distal fenestrations with ancillary devices in patients with subacute or chronic Crawford type III and IV aortic dissection aneurysm.Methods: All patients underwent either TEVAR for primary entry tear; subsequently, various ancillary devices were applied on each distal fenestration. These techniques included covered stent occlusion of detached visceral artery entry tears, TL stenting and FL occlusion with vascular plugs in the common iliac artery dissection, or TEVAR coverage for multiple fenestrations from segmental arteries. This case series included nine patients (seven men and two women; mean age: 63.4 years) during January 2013 to May 2019. Outcome analysis included the rates of technical success and procedure-related complications, completeness of FL occlusion, aortic remodeling, and midterm mortality at 2 years.Results: The mean follow-up duration was 37.7 months without in-hospital mortality. One patient was lost to follow-up at the second month, the rest of patients were all alive during the follow-up period. All patients achieved complete FL thrombosis, and six patients exhibited aneurysm diameter shrinkage.Conclusion: Tailored exclusion of visceral and iliac distal fenestrations with proximal primary tear coverage can promote FL thrombosis and aortic remodeling in the visceral aortic segment in patients with Crawford type III or IV aortic dissection aneurysm. [ABSTRACT FROM AUTHOR]

To describe characteristics associated with long-term outcomes in severe COVID-19 patients admitted to a post-acute care facility (PACF). Prospective cohort. Consecutive severe COVID-19 admitted to a PACF from April 2020 to August 2021. Patients were followed for 180 days after discharge. Functional outcomes were measured by the modified Barthel index and further stratified into good outcome (for those independent, mildly dependent, or moderately dependent) and into bad outcome (for those severely dependent, completely dependent, or dead). Multivariate binary logistic regression was performed to evaluate between patients' characteristics and long-term outcomes. A total of 186 patients admitted from 17 different acute hospitals were included. Median age was 67 years, 88% of patients were previously independent, 95% were admitted to the ICU, and 85% were mechanically ventilated during the acute hospitalization. Median (interquartile range) Barthel indexes at admission, discharge, and 180-day follow-up were 9 (1-23), 81 (45-92), and 100 (98-100) (P <.001), respectively. In addition, 180-day mortality was 17.2%. Baseline functional status, comorbidities, and functional status at admission to the PACF were associated with bad outcome at 180-day follow-up, after multivariate binary logistic regression. Patients with severe COVID-19 admitted to a PACF had substantial functional improvements at PACF discharge and during 180-day follow-up. These findings may help prognosticate and manage post-acute severe COVID-19 patients. [ABSTRACT FROM AUTHOR]

We sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries, reaching up to the COVID-19 pandemic (2015–2019). Retrospective, observational using 100% sample of Medicare Provider Analysis and Review file (MedPAR), the Medicare Beneficiary Summary File, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS). Medicare beneficiaries aged 66 and older enrolled in MA or TM who were hospitalized and discharged alive. We first calculated the proportions of MA and TM beneficiaries who were hospitalized and who used any post-acute care, as well as the total number of days of post-acute care used. We also calculated the size of the post-acute care network used by TM and MA beneficiaries within each hospital in our sample and the measured quality (star ratings) of the post-acute care providers used. We found hospitalizations, SNF stays, and HH stays were all decreasing over time in both populations. Although similar proportions of MA and TM beneficiaries received SNF or HH care, MA beneficiaries received fewer days. The largest difference we found was in the number of post-acute care providers used in TM and MA, with MA using far fewer; however, quality ratings were similar among post-acute care providers used in each program. Together, these results suggest MA beneficiaries have fewer days in post-acute care, receive care from fewer providers of similar measured quality to TM, but have a similar number of days outside the hospital or SNF in the first 100 days after hospital discharge. [ABSTRACT FROM AUTHOR]