Defining ready for discharge from sub-acute care: a qualitative exploration from multiple stakeholder perspectives.

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.

Sub-Acute Toxicity Study of Pegagan Embun (Hydrocotyle Sibthorpioides Lam.) Extract on the Sgpt and Sgot Level of Wistar White Male Rats

Objective: Pegagan embun (Hydrocotyle sibthorpioides Lam.) is one of the herbs used in ethnomedicines as an immunostimulant during the COVID-19 pandemic. This present study aims to discover the potential toxicity effect of pegagan embun extract through sub-acute administration on the SGPT and SGOT levels of Wistar white male rats. Method(s): Thirty-six test animals were divided into four groups: the control group was given Na CMC 0.5%, and the treatment groups were treated with ethanol extract of pegagan embun at doses of 7, 35, and 150 mg/kgBW. All groups were treated orally for 7, 14, and 21 d once daily. On the 8th, 15th, and 22nd day, the SGPT and SGOT of the test animal level were measured. The data were analyzed by two-way ANOVA followed by Duncan's multiple range test (p<0.05). Result(s): The study revealed that administration of pegagan embun extract did not cause any harmful effect on the liver but significantly decreased the level of SGPT and SGOT influenced by the variety of doses and duration of administration (p<0.05). Significant reductions in SGPT and SGOT levels are seen after extract administration at dosages of 7 mg/kgBW for 21 d. Conclusion(s): This study showed that pegagan embun (Hydrocotyle sibthorpioides Lam.) extract sub-acute administration at doses of 7, 35, and 150 mg/kgBW is relatively non-toxic and safe to be used as an immunostimulant. There was no sign of damage showed in the liver of treated rats based on the levels of SGOT and SGPT.Copyright © 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd.

Post-Vaccination/Post-COVID Immune-Mediated Demyelination of the Brain and Spinal Cord: A Novel Neuroimaging Finding.

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which not only produces respiratory symptoms but is known to involve almost every system, and its neuroinvasive properties have been well demonstrated throughout the pandemic. Also, to combat the pandemic, there was rapid development and induction of various vaccination drives, following which many adverse events following immunization (AEFIs) have been reported, which include neurological complications as well. Method: We present a series of three cases, post vaccination, with and without a history of COVID illness that showed remarkably similar findings on magnetic resonance imaging (MRI). Result: A 38-year-old male presented with complaints of weakness of the bilateral lower limbs with sensory loss and bladder disturbance a day after receiving his first dose of ChadOx1 nCoV-19 (COVISHIELD) vaccine. A 50-year-old male with hypothyroidism characterized by autoimmune thyroiditis and impaired glucose tolerance experienced difficulty in walking 11.5 weeks after being administered with COVID vaccine (COVAXIN). A 38-year-old male presented with subacute onset progressive symmetric quadriparesis 2 months after their first dose of a COVID vaccine. The patient also had sensory ataxia, and his vibration sensation was impaired below C7. All three patients had typical pattern of involvement of the brain and spine on MRI with signal changes in bilateral corticospinal tracts, trigeminal tracts in the brain, and both lateral and posterior columns in the spine. Conclusion: This pattern of brain and spine involvement on MRI is a novel finding and is likely a result of post-vaccination/post-COVID immune-mediated demyelination.

Acute and Sub-Acute Toxicity Studies of the Siddha Preparation Mv Kashayamin Wistar Rats

The acute and sub-acute toxicity analysis of Siddha preparation MV kashayam was carried out with Wistar rats as per the guidelines 423 and 407of the Organization for Economic Co-operation and Development (OECD), respectively. In the acute toxicity study, a single dose of MV kashayam (1000 and 2000 mg/kg body weight) was administered orally to the rats and monitored for 14 days. In the sub-acute toxicity study, rats were orally administered with MV kashayam daily for 28 days at doses of 100 and 200 mg/kg body weight. In both the toxicity study, no rats have exhibited clinical signs of toxicity or mortality, and the doses were well tolerated by rats and no significant change in their mean body weight, food and water intake, haematological, biochemical parameters and his to pathological examinations as compared to that of control group rats. The findings suggest that MV kashayam has a wide margin of safety and a negligible amount of toxicity to ensure the safety and potency of the kashayam, which can be recommended to use as a novel prophylactic and therapeutic agent for COVID 19 based on the clinical study. All Copyright © 2022 are reserved by International Journal of Pharmaceutical Sciences and Research.

Sub-acute Onset of Guillain-Barré Syndrome Post-mRNA-1273 Vaccination: a Case Report.

Ever since the start of the pandemic, SARS-CoV-2 has taken the lives of millions of people around the globe. Several COVID-19 vaccines have been developed with rapidity to prevent acquiring COVID-19 infection, hospitalizations, and deaths. The routine side effects of these vaccines are commonly known and non-severe. Few serious side effects such as thrombosis with thrombocytopenia syndrome (TTS) and Guillain-Barré syndrome (GBS) are increasingly reported particularly after inoculation with ChAdOx1 nCoV-19 (Oxford/AstraZeneca) and Ad26.COV 2.S (Johnson & Johnson's Janssen). Rare cases of GBS after BNT162b2 (Pfizer-BioNTech), an mRNA vaccine, are also reported. However, the true association of these cases to COVID-19 continues to be unclear and the safety of these vaccines continues to be great in preventing deaths from COVID-19 infection. We report a case of middle-aged female who had a gradual onset of lower extremity weakness with a nadir of symptoms reached 10 and 12 weeks after the onset. This protracted course (sub-acute) is atypical for a "classical" GBS. The presence of an antecedent event, autonomic symptoms such as hypotension, and the need for ventilator support favored the diagnosis of GBS than chronic inflammatory demyelinating polyneuropathy (CIDP). This is the first known case to be reported of sub-acute onset of Guillain-Barré syndrome after receiving the mRNA-1273 vaccine. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42399-022-01124-1.

Reactive Exercises with Interactive Objects: Interim Analysis of a Randomized Trial on Task-Driven NMES Grasp Rehabilitation for Subacute and Early Chronic Stroke Patients.

Enriched environments and tools are believed to promote grasp rehabilitation after stroke. We designed S2, an interactive grasp rehabilitation system consisting of smart objects, custom orthoses for selective grasp constraining, and an electrode array system for forearm NMES. Motor improvements and perceived usability of a new enriched upper limb training system for sub-acute stroke patients was assessed in this interim analysis. INCLUSION CRITERIA: sub-acute stroke patients with MMSE>20, ipsilesional MI>80%, and contralesional MI<80%. Effects of 30-min therapy supplements, conventional vs. S2 prototype, are compared through a parallel two-arms dose-matched open-label trial, lasting 27 sessions. Clinical centres: Asklepios Neurologische Klinik Falkenstein, Königstein im Taunus, Germany, and Clinica Villa Beretta, Costa Masnaga, Italy. Assessment scales: ARAT, System Usability, and Technology Acceptance. METHODOLOGY: 26 participants were block randomized, allocated to the study (control N=12, experimental N=14) and underwent the training protocol. Among them, 11 participants with ARAT score at inclusion below 35, n = 6 in the experimental group, and n = 5 in the control group were analysed. RESULTS: participants in the enriched treatment group displayed a larger improvement in the ARAT scale (+14.9 pts, pval=0.0494). Perceived usability differed between clinics. No adverse effect was observed in relation to the treatments. Trial status: closed. CONCLUSIONS: The S2 system, developed according to shared clinical directives, was tested in a clinical proof of concept. Variations of ARAT scores confirm the feasibility of clinical investigation for hand rehabilitation after stroke.