Medical Data Acquisition and Internet of Things Technology-Based Cerebral Stroke Disease Prevention and Rehabilitation Nursing Mobile Medical Management System.

This research was aimed at exploring the application value of a mobile medical management system based on Internet of Things technology and medical data collection in stroke disease prevention and rehabilitation nursing. In this study, on the basis of radio frequency identification (RFID) technology, the signals collected by the sensor were filtered by the optimized median filtering algorithm, and a rehabilitation nursing evaluation model was established based on the backpropagation (BP) neural network. The performance of the medical management system was verified in 32 rehabilitation patients with hemiplegia after stroke and 6 healthy medical staff in the rehabilitation medical center of the hospital. The results showed that the mean square error (MSE) and peak signal-to-noise ratio (PSNR) of the median filtering algorithm after optimization were significantly higher than those before optimization (P < 0.05). When the number of neurons was 23, the prediction accuracy of the test set reached a maximum of 89.83%. Using traingda as the training function, the model had the lowest training time and root mean squared error (RMSE) value of 2.5 s and 0.29, respectively, which were significantly lower than the traingd and traingdm functions (P < 0.01). The error percentage and RMSE of the model reached a minimum of 7.56% and 0.25, respectively, when the transfer functions of both the hidden and input layers were tansig. The prediction accuracy in stages III~VI was 90.63%. It indicated that the mobile medical management system established based on Internet of Things technology and medical data collection has certain application value for the prevention and rehabilitation nursing of stroke patients, which provides a new idea for the diagnosis, treatment, and rehabilitation of stroke patients.

Validation of the ICU Mobility Scale for Nursing Use: Portuguese Multicentric Observational Study.

BACKGROUND AND PURPOSE: Mobilization of critical patients should be precocious and the inclusion of nursing in this task can be decisive in paradigm shift. The purpose of this study was to validate the Portuguese version of the intensive care unit Mobility Scale for nursing use. METHODS: Prospective multicenter observational study. Patients' mobility was evaluated by rehabilitation nurses in order to determine interobserver agreement. The validation criteria was tested by determining the correlation between the evaluation results of mobility, strength, and functionality levels at discharge. RESULTS: Good interobserver agreement (R = 0.98; K = 0.76). Positive correlation with muscle strength (R = 0.77) and functionality (R = 0.85) levels at discharge. CONCLUSIONS: Based on the correlations observed the scale is a valid instrument for nurses and could be a useful tool for routine use. More research is recommended to make the results more robust.

Association of Length of Stay, Recovery Rate, and Therapy Time per Day With Functional Outcomes After Hip Fracture Surgery.

Importance: Medicare is shifting from payment for postacute care services based on the volume provided to payment based on value as determined by patient characteristics and functional outcomes. Matching therapy time and length of stay (LOS) to patient needs will be critical to optimize functional outcomes and manage costs. Objective: To investigate the association among therapy time, LOS, and functional outcomes for patients following hip fracture surgery. Design, Setting, and Participants: This retrospective cohort study analyzed data on patients from 4 inpatient rehabilitation facilities and 7 skilled nursing facilities in the eastern and midwestern United States. Participants were patients aged 65 years or older who received inpatient rehabilitation services for hip fracture and had Medicare fee-for-service as their primary payer. Data were collected from 2005 to 2010. Analysis was conducted from November 2018 to June 2019. Exposure: Therapy minutes per LOS day. Main Outcomes and Measures: Functional Independence Measure mobility and self-care measures at discharge. Patients were categorized into 9 recovery groups based on low, medium, or high therapy minutes per LOS day and low, medium, or high rate of functional gain per day. Results: A total of 150 patients (101 [67.3%] female; 148 [98.6%] white; mean [SD] age, 82.0 [7.3] years) met inclusion criteria. Participants in all gain and therapy minutes per LOS day trajectories were similar in function at rehabilitation admission (mean [SD] mobility, 16.2 [3.2]; F8,141 = 1.26; P = .27) but differed significantly at discharge (mean [SD] mobility, 23.9 [5.2]; F8,141 = 14.34; P < .001). High-gain patients achieved mobility independence by discharge; low-gain patients needed assistance on nearly all mobility tasks. Medium-gain patients with a mean LOS of 27 days were independent in mobility at discharge; those with a mean LOS less than 21 days needed supervision with toilet transfers and were dependent with stairs. Length of stay and functional gain rate explained much of the variance in mobility and self-care scores at discharge. Although medium- and high-therapy minutes per LOS day groups were statistically significant in the regression model (ß = 6.99; P = .001; and ß = 11.46; P = .007, respectively), they explained only 1% of the variance in discharge outcome. Marginal means suggest that medium-gain patients with shorter LOS would have achieved mobility independence if LOS had been extended. Conclusions and Relevance: In this study, rate of recovery and LOS in skilled nursing and inpatient rehabilitation facilities were associated with mobility and self-care outcomes at discharge following hip fracture surgery, particularly for medium-gain patients. Therapy time per day explained only 1% of the variance in discharge outcome. Discharging medium-gain patients before 21 days LOS may transfer burden of care to family and caregivers, home health, and outpatient services.

Improving Patient Safety Through Video Monitoring.

PURPOSE: Falls are a major safety issue in rehabilitation settings. Patients receive mixed messages-try to be as independent as possible, but don't do anything in your room without calling for assistance. Despite the use of multiple falls interventions at this facility, the fall rate remained high. To impact this rate, the facility implemented a video monitoring system. This system allows for patients at risk for falling to be monitored from a remote location. The monitor technician is able to speak to the patient directly and/or contact staff members to respond to the room, preventing a fall. DESIGN: Sequential cohort design. METHOD: Fifteen video monitoring units were installed on high-risk units in a 115-bed inpatient rehabilitation facility. Total falls and falls rates were tracked and reported pre- and postimplementation. FINDINGS: Over a 21-month period prior to implementing the video monitoring system, the average hospital-wide rate of falls was 6.34 per 1,000 patient-days (SD = 1.7488). After a year of usage, that average has decreased to 5.099 falls per 1,000 patient-days (SD = 1.524). The reduction in falls was statistically significant. In addition, there have been significant cost savings by reducing sitter usage. CONCLUSIONS: Video monitoring can improve patient safety by decreasing falls; decreasing sitter usage and cost; and improving patient, family, and staff satisfaction. CLINICAL RELEVANCE: Falls are a significant issue in rehabilitation settings, and current fall prevention strategies fall short of reducing fall rates. Implementation of new video monitoring technology can help reduce fall rates in inpatient rehabilitation settings.

Capturing Functional Independence Measure (FIM®) Ratings.

PURPOSE: The aim of the study was to identify interventions to capture admission functional independence measure (FIM®) ratings on the day of admission to an inpatient rehabilitation facility. DESIGN: A quantitative evidence-based practice quality improvement study utilizing descriptive statistics. METHODS: Admission FIM® ratings from patients discharged in June 2012 (retrospective review) were compared to admission FIM® ratings from patients discharged in June 2014 (prospective review). The logic model was utilized to determine the project inputs, outputs, and outcomes. FINDINGS: Interventions to capture admission FIM® ratings on the day of admission are essential to accurately predict the patient's burden of care, length of stay, and reimbursement. Waiting until Day 2 or Day 3 after admission to capture the admission FIM® assessment resulted in inflated admission FIM® ratings and suboptimal quality outcomes. CONCLUSION/CLINICAL RELEVANCE: Interventions to capture admission FIM® ratings on the day of admission were successful at improving the quality of care, length of stay efficiency, and accurately recording admission FIM® ratings to determine the patient's burden of care.

A Psychometric Evaluation of the Chinese Version of the M.D. Anderson Symptom Inventory-Heart Failure in Chinese Cancer Patients With Concurrent Heart Failure.

PURPOSE: The purpose of the study was to translate the M.D. Anderson Symptom Inventory-Heart Failure (MDASI-HF), a specific instrument to assess symptoms in cancer patients with concurrent heart failure (HF), into Mandarin Chinese and to examine its psychometric properties in Chinese cancer patients. DESIGN: A translation and psychometric evaluation design was used. METHODS: The translation of the MDASI-HF into Mandarin Chinese followed Brislin's model with the four steps: translation, monolingual assessment, backward translation, and comparison. The Chinese version MDASI-HF was tested among 135 cancer patients with concurrent HF from a cancer hospital in Tianjin, China. Psychometric properties of content validity, internal consistency, test- retest reliability, concurrent validity, and sensitivity of the instrument were evaluated. FINDINGS: The Cronbach's α was .913 for the core items, .835 for the HF items, and .897 for the interference items. The test-retest reliability was satisfactory with intraclass coefficients > .9 and content validity index was .94. The Chinese version MDASI-HF was significantly correlated with the Eastern Cooperative Oncology Group performance grade (correlation coefficients .456-.600) and the New York Heart Association classification (correlation coefficients .477-.631), indicating the established concurrent validity of the translated instrument. CONCLUSIONS: The Chinese version MDASI-HF is a valid and reliable instrument to assess the symptoms of Chinese cancer patients with concurrent HF. CLINICAL RELEVANCE: Symptom assessment and management play important roles in cancer rehabilitation. The Chinese version MDASI-HF can assist appropriate and timely symptom assessment in cancer patients with concurrent HF and can promote communication between healthcare professionals and patients. On the basis of the assessment, the rehabilitation team could provide effective symptom management, evaluate the effectiveness of interventions, and improve patients' quality of life.

Validity of the Original and Short Versions of the Dynamic Gait Index in Predicting Falls in Stroke Survivors.

PURPOSE: This study aimed to investigate the validity of the original version and short version of the Dynamic Gait Index (DGI-8 and DGI-4) in predicting falls in stroke survivors. DESIGN: This is a retrospective, cross-sectional study. METHOD: This study collected data for 57 chronic stroke survivors and evaluated the validity of the DGI-8 and DGI-4. To test functional ability, the Sit-to-Stand Test, gait subscale of the Performance-Oriented Mobility Assessment, the 10-m Walk Test, the Fugl-Meyer assessment, and the Trunk Impairment Scale were used. FINDINGS: For the DGI-8, the cutoff value for the prediction of a fall was shown to be 16.5, with an area under the curve (AUC) of 0.78. The cutoff value of the DGI-4 was shown to be 9.5, with an AUC of 0.77. CONCLUSIONS: The study results show that the DGI-8 and DGI-4 have discrimination in the prediction of fall in stroke survivors. CLINICAL RELEVANCE: DGI-8 and DGI-4 can be useful for predicting falls of stroke patients, allowing better quality of care.

Nurse Satisfaction and Burnout in Shanghai Neurology Wards.

PURPOSE: To explore satisfaction and burnout of nurses working in neurology wards in Shanghai, China. DESIGN: A descriptive cross-sectional questionnaire survey. METHODS: Three hundred and eighty-seven nurses from 23 neurology wards in 21 tertiary general hospitals were recruited using cluster sampling. The valid response rate was 94.83%. FINDINGS: Nurse satisfaction with the salary/wages, the job and the nurse staffing level were 21.79%, 37.33%, and 40.87%. A high nurse burnout rate was found as: emotional exhaustion (EE) ≥ 27 (89.92%); depersonalization (DP) ≥ 10 (92.64%); and reduced personal accomplishment (PA)≤ 33 (79.29%). CONCLUSIONS: Most nurses in the neurology wards were dissatisfied and had high levels of burnout. Experienced, intermediate and senior nurses were at the highest risk for job turnover. CLINICAL RELEVANCE: Nurse administrators should take effective measures to increase nurse satisfaction and decrease burnout to retain experienced nurses and keep the stability of nursing workforce.

Identifying Risk Factors for Elder Falls in Geriatric Rehabilitation in Israel.

PURPOSE: To identify risk factors for elder falls in a geriatric rehabilitation center in Israel. DESIGN: Retrospective chart review study. METHODS: Four hundred and twelve medical records of inpatients in geriatric rehabilitation were retrospectively analyzed to compare between elders who sustained falls and those who did not. FINDINGS: Of elders hospitalized during this year, 14% sustained falls. Fallers included a high proportion of males, with little comorbidity, not obese, and cardiovascular patients. Falls occurred frequently during patients' first week at the facility, mostly during the daytime. The falls occurred frequently in patients' rooms, and a common scenario was a fall during transition. CONCLUSIONS: The research findings single out patients who are allegedly at a lower risk of falls than more complex patients. CLINICAL RELEVANCE: Caregivers in geriatric rehabilitation settings should pay attention to patients who are allegedly at a lower risk of falls than more complex patients, and to cardiovascular patients in particular.

Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes.

PURPOSE: To examine the association of inpatient rehabilitation facility (IRF) length of stay (LOS) with stroke patient outcomes. DESIGN: A secondary data analysis of the Uniform Data System for Medical Rehabilitation database. METHODS: Stroke patients discharged from IRFs in the United States between 2009 and 2011 were identified and divided into mild (n = 639), moderate (n = 2,065), and severely (n = 2,077) impaired groups. Study outcomes included cognition and motor functional gains measured by the Functional Independence Measure (FIM) instrument and discharge to the community. FINDINGS: The average LOS was 8.9, 13.9, and 22.2 days for mild, moderate, and severely impaired stroke patients, respectively. After controlling for FIM admission and other important covariates, a longer LOS was associated with a modest increase in cognition gain (ß = 0.038, p = .0045) for the moderately impaired patients, and a modest increase in cognition (ß = 0.13, p < .0001) and motor gains (ß = 0.25, p < .0001) as well as a tendency for discharge to the community (OR = 1.01, 95% CI = 1.00-1.02) among the severely impaired patients. However, a longer LOS showed a negative association with functional gains among the mildly impaired patients as well as discharge to community for both mild and moderately impaired patients. CONCLUSION: The association of IRF LOS and patient outcomes varied by stroke impairment severity, positively for more severely impaired patients and negatively for mildly impaired patients. CLINICAL RELEVANCE: The study provides evidence for the care of stroke patients at the IRF setting.

[Inpatient Preventative and Rehabilitative Treatment for Informal Caregivers - An Explorative Investigation of Specific Offers in Germany]. / Stationäre Rehabilitation und Vorsorge für pflegende Angehörige - eine Sondierung der Angebote in Deutschland.

INTRODUCTION: In line with a new law in 2012 (Pflege-Neuausrichtungs-Gesetz) a special regard to informal care givers in inpatient rehabilitation and prevention facilities was established. Thus possibilities were created to facilitate care for people requiring nursing within the rehabilitation hospital while the informal caregiver is treated. On behalf of the German Ministry of Health the BQS Institute of Quality and Patient Safety analysed what specific offers for this target group are available in the rehabilitation setting and to what extent the requirements of the new law are already implemented. METHODS: To identify those specific offers for informal caregivers, a nationwide e-mail survey was conducted in 1,167 rehabilitation hospitals in Germany which was complemented with an internet research. Additionally semi-standardised interviews with 28 experts in different specialty fields as well as a literature research were conducted. RESULTS: 31 rehabilitation hospitals were identified, which provide specific measures for informal caregivers and 53 hospitals which provide care for the dependent person, too (overlaps are possible). By providing those offers, the providers are in unchartered waters in regard to concepts. Usually providers are relating to already existing measures in their indication areas and extend those through specific measures. To date, a targeted allocation of informal caregivers to appropriate facilities is not established.

Factors Influencing Outpatient Cardiac Rehabilitation Attendance.

PURPOSE: In the current health climate, the length of stay of cardiac patients in hospital has been decreasing, and this has significantly reduced the time nurses and colleagues have for providing inpatient cardiac rehabilitation (CR). The purpose of this research was to determine if inpatient CR has an influence on outpatient cardiac rehabilitation attendance for women, Maori, and older people. METHODS: An audit of patients discharged from hospital between November 2011 and July 2012 with a diagnosis of acute coronary syndrome were sent a postal questionnaire. FINDINGS: The survey was completed by 143 people: 46% female, 12% Maori, and 70% > 65 years. Only 38% attended outpatient CR on discharge. Reasons for not attending included lack of referral to CR, and 61% understood only some/none of the information given to them while in hospital. The Cardiac Rehabilitation Coordinator most consistently recommended attendance, but this invitation was extended after discharge from hospital. CONCLUSIONS: Attendance at outpatient CR is low and may increase with an improved individualized plan of care including greater cultural considerations and attention to discharge planning. An automatic referral tool as well as following evidence-based guidelines for inpatient care may increase participation rates for CR. CLINICAL RELEVANCE: Nursing staff have the majority of contact with patients and it appears that very few nurses are discussing CR programs with their patients. The information to attend CR should be offered by all of the health professionals patients meet during their stay in hospital.

[Catalogues of therapeutic nursing activities in neurological early rehabilitation]. / Leistungskataloge der aktivierend-therapeutischen Pflege in der neurologischen Frührehabilitation.

Under the German DRG-system, hospital-based rehabilitation of still critically ill patients becomes increasingly important. The code for early neurological rehabilitation in the DRG-system's (Diagnosis Related Groups) list of operations and procedures requires an average daily therapeutic intensity of 300 min, part of which is being contributed by therapeutic nursing. As therapeutic aspects are integrated in other nursing activities, it is difficult to separate its time consumption. This problem is pragmatically resolved by catalogues of therapeutic nursing activities which assign plausible amounts of therapeutic minutes to each activity. The 4 catalogues that are used most often are described and compared. Nursing science has not focused yet on therapeutic nursing.

[The validity of the "Working Group on Nursing in Early Rehabilitation" (AGnFP) catalogue]. / Dokumentation von Leistungen der therapeutisch-aktivierenden Pflege in der neurologisch-neurochirurgischen Frührehabilitationmit Hilfe des Katalogs der niedersächsischen "Arbeitsgemeinschaftneurologische Frührehabilitationspflege" (AGnFP).

INTRODUCTION: Nursing is most important in neurological early rehabilitation to achieve a good outcome. In the present study, the validity of the catalogue of the "Working Group on Nursing in Early Rehabilitation" (AGnFP) has been examined. METHODS: 54 neurological early rehabilitation patients (mean age 68.3 (14.7) years) have been enrolled. All nursing processes (basic and medical care) have been documented through timekeeping. RESULTS: A nursing total of 205.9 (122.6) min/d per patient was found. In the AGnFP-catalogue, 177.5 (130.9) min/d have been documented (86.2% of all nursing processes). Barthel-index correlated negatively with basic nursing care (r = − 0.42, p < 0.01). The early rehabilitation index showed a negative correlation with medical nursing processes (r = − 0.46, p < 0.01). The AGnFP catalogue correlated with basic nursing processes (r = 0.69, p < 0.001). DISCUSSION: The AGnFP-catalogue is a tool to document nursing in early neurological rehabilitation. Further studies are strongly encouraged.

Physical therapists versus nurses in a rehabilitation hospital: comparing prevalence of work-related musculoskeletal complaints and working conditions.

The objective of this study was to investigate the prevalence and work avoidance of work-related musculoskeletal complaints and to compare patient handling tasks and psychosocial factors of physical therapists (PTs) and nurses in a rehabilitation hospital. Cross-sectional observational study was carried out using questionnaires relating to basic demographics, prevalence of musculoskeletal morbidity, workload, and job satisfaction. Comparing 26 PTs and 54 nurses, all females, lower back pain was significantly more prevalent in PTs, even after adjusting for the confounding demographic factors; PTs performed full and partial manual patient transfer, as well as trunk bending and walking assistance more frequently than the nurses and were significantly more satisfied. Unique physical load could be the main factor for the high prevalence of lower back pain in PTs. They should urgently initiate a "no-lift policy" in treatment.

Occupational back pain among rehabilitation nurses in Saudi Arabia: the influence of knowledge and awareness.

Occupational low back pain among nurses has been the subject of research studies worldwide. However, evidence of the influence of nurses' awareness of safe handling practices and compliance with standard guidelines on low back pain remains scarce. This study examined the association between occupational low back pain and level of awareness of back care, and described the self-reported nature of low back pain in relation to organizational policies among nurses in Saudi Arabia. A total of 155 nurses working in a rehabilitation hospital participated in the study. The lack of a patient handling policy at the workplace was identified as a significant risk factor for the development of low back pain, whereas exercising regularly was a protective factor. Not only mechanical exposure but also organizational factors and level of awareness were related to the development of low back pain. This study highlights the need to develop institutional plans for injury reporting, and provides evidence of the importance of incorporating awareness as part of prevention strategies.

Medicare prospective payment and the volume and intensity of skilled nursing facility services.

In 1998, Medicare adopted a per diem Prospective Payment System (PPS) for skilled nursing facility care, which was intended to deter the use of high-cost rehabilitative services. The average per diem decreased under the PPS, but because per diems increased for greater therapy minutes, the ability of the PPS to deter the use of high-intensity services was questionable. In this study, we assess how the PPS affected the volume and intensity of Medicare services. By volume we mean the product of the number of Medicare residents in a facility and the average length-of-stay, by intensity we mean the time per week devoted to rehabilitation therapy. Our results indicate that the number of Medicare residents decreased under PPS, but rehabilitative services and therapy minutes increased while length-of-stay remained relatively constant. Not surprisingly, when subsequent Medicare policy changes increased payment rates, Medicare volume far surpassed the levels seen in the pre-PPS period.

The Barthel Index: comparing inter-rater reliability between nurses and doctors in an older adult rehabilitation unit.

OBJECTIVE: To ensure accuracy in recording the Barthel Index (BI) in older people, it is essential to determine who is best placed to administer the index. The aim of this study was to compare doctors' and nurses' reliability in scoring the BI. METHODS: Sixty-five consecutive patients admitted to an older adult rehabilitation unit were assessed using the BI. Four raters recorded the BI on all patients. BI scores were compared for equivalence on the level of agreement between raters. RESULTS: Near-perfect correlation in the total scores between raters indicated that the final score is reliable. There was a statistically significant bias by doctors who gave a higher BI score than nurses with a mean difference of 1.2 (95% confidence interval). Nurses demonstrated good and very good agreement on all 10 items, whereas doctors demonstrated good agreement on only 5 items. CONCLUSION: The BI is highly reliable when recorded by nurses with low interrater variation, whereas between doctors, there is greater variation. When assessing older adult's activities of daily living, there is greater interrater reliability in the BI score when the patient is observed performing the activities of daily living compared to the self-report method.

Risk factors associated with patient assaults of home healthcare workers.

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47-12.67), routinely handling patients (OR = 8.48, 95% CI 1.89-37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75-11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.

Exploring uptake of cardiac rehabilitation in a minority ethnic population in England: a qualitative study.

BACKGROUND: In the United Kingdom ethnic minority groups from the Indian sub-continent (India, Pakistan and Bangladesh) are at increased risk of coronary heart disease related mortality and morbidity. Variation in prevalence and outcome is in part related to access to appropriate health care. AIMS: This study explores the experiences of participants following an acute cardiac event; with a specific focus on reasons for the take up of cardiac rehabilitation services. METHODS: Twenty participants (12 Pakistani, 6 Indian and 2 Bangladeshi) eligible for CR were interviewed using a semi-structured format. RESULTS: Previous negative experience of the health care service related to communication difficulties was an important factor for not engaging with cardiac rehabilitation services. The importance of interventions by professional friends and family members appeared to increase appropriate access to care. Gender and religious beliefs were also important aspects that had an impact on uptake of services. Reasons for non-attendance were also related to service provision (setting and timing of classes), practical considerations (language barrier and transport problems), and poor understanding of cardiac rehabilitation. CONCLUSIONS: The findings highlight significant barriers to uptake at the participant level which require changes at the system and provider level if uptake is to improve.