Associations of hospital discharge services with potentially avoidable readmissions within 30 days among older adults after rehabilitation in acute care hospitals in Tokyo, Japan
انجمن خدمات ترخیص بیمارستان با بستری مجدد بالقوه قابل اجتناب در عرض 30 روز در میان سالمندان بعد از توانبخشی در بیمارستانهای مراقبت حاد در توکیو ، ژاپن-2020
OBJECTIVE: To examine the associations of three major hospital discharge services covered under health insurance (discharge planning, rehabilitation discharge instruction, and coordination with community care) with potentially avoidable readmissions within 30 days (30-day PAR) in older adults after rehabilitation in acute care hospitals in Tokyo, Japan.
DESIGN: Retrospective cohort study using a large-scale medical claims database of all Tokyo residents aged ≥75 years. SETTING: Acute care hospitals PARTICIPANTS: Patients who underwent rehabilitation and were discharged to home (n=31,247; mean age: 84.1 years, standard deviation: 5.7 years) between October 2013 and July 2014.
MAIN OUTCOME MEASURE: 30-day PAR.
RESULTS: Among the patients, 883 (2.9%) experienced 30-day PAR. A multivariable logistic generalized estimating equation model (with a logit link function and binominal sampling distribution) that adjusted for patient characteristics and clustering within hospitals showed that the discharge services were not significantly associated with 30-day PAR. The odds ratios were 0.962 (95% confidence interval [CI]: 0.805-1.151) for discharge planning, 1.060 (95% CI: 0.916-1.227) for rehabilitation discharge instruction, and 1.118 (95% CI: 0.817-1.529) for coordination with community care. In contrast, the odds of 30-day PAR among patients with home medical care services were 1.431 times higher than those of patients without these services (P<0.001), and the odds of 30-day PAR among patients with a higher number (median or higher) of rehabilitation units were 2.031 times higher than those of patients with a lower number (below median) (P<0.001). Also, the odds of 30-day PAR among patients with a higher hospital frailty risk score (median or higher) were 1.252 times higher than those of patients with a lower score (below median) (P=0.001).
CONCLUSIONS: The insurance-covered discharge services were not associated with 30-day PAR, and the development of comprehensive transitional care programs through the integration of existing discharge services may help to reduce such readmissions.
Copyright © 2020. Published by Elsevier Inc.
KEYWORDS: Big data; health services for the aged; patient readmission; rehabilitation; transitional care
Accounting for the ‘deviant’ in 19th century Italian prisons
حسابداری "منحرف" در زندانهای ایتالیایی قرن نوزدهم-2019
Studies of accounting in prisons have documented how the dominance of neo-liberal preferences in the management of prison systems has meant a focus on measuring costeffectiveness and discharging accountability in a way which ignores important aspects of prison life such as decency and rehabilitation. The present work recognises the need for accounting studies to unmask the prejudiced, interested and potentially socially damaging use of accounting in prison reform by exposing how accounting is often a tool which can be used to discipline individuals consistent with the values of economic and political elites within a society. By applying a Foucauldian lens to the analysis of the prison systems of the major Italian States in the early 19th century, the study shows how accounting was an essential aid in ensuring that the correction of individuals was carried out consistent with the moral priorities of the liberal bourgeois society of the time. The specific visibilities created by means of accounting, upon which decisions on the life of prisoners were made and which still characterise modern prisons, reduced human life to a simplistic numerical representation. These were then used to reconstruct ‘deviant’ individuals as productive, obedient citizens, regardless of their specific circumstances
Keywords: Accounting | Prison | Foucault | Liberal values
Alcohol and the Law
الکل و قانون-2019
It is important for physicians to be aware of the local procedures for reporting alcohol use and related impairment and to have some knowledge of the law applicable in the jurisdiction where they practice. The physician’s duty is patient education with an ethical and legal duty to warn the patient of the adverse personal and societal effects of alcohol. If possible, family support should be enlisted and alcohol rehabilitation efforts pursued. The physician should explicitly document all good faith efforts to accomplish these initiatives. Warning third parties of the potential for harm related to an individual patient’s alcoholrelated impairment may involve a breach of patient confidentiality. Disclosure to a third party should be undertaken only if the risk of significant harm exceeds the burden that will result to the patient from warning others. Although specific laws,
KEYWORDS : Alcohol | Law | Public safety | Alcohol-related impairment | Patient confidentiality
Serious games for rehabilitation: Gestural interaction in personalized gamified exercises through a recommender system
بازی های جدی برای توانبخشی: تعامل حرکاتی در تمرینات شخصی سازی شده شخصی از طریق سیستم توصیه کننده-2019
One of the principal problems of rehabilitation is that therapy sessions can be boring due the repetition of exercises. Serious games, and in particular exergames in rehabilitation, can motivate, engage and increase patients’ adherence to their treatment. Also, the automatic personalization of exercises to each patient can help therapists. Thus, the main objective of this work is to build an intelligent exergame-based rehabilitation system consisting of a platform with an exergame player and a designer tool. The intelligent platform includes a recommender system which analyzes user interactions, along with the user’s history, to select new gamified exercises for the user. The main contributions of this paper focus, first, on defining a recommender system based on different difficulty levels and user skills. The recommender system offers the ability to provide the user with a personalized game mode based on his own history and preferences. The results of a triple validation with experts, users and rehabilitation center professionals reveal a positive impact on gestural interaction and rehabilitation uses. Also, different methods are presented for testing the rehabilitation recommender system.
Keywords: Recommender systems | Exergames | Rehabilitation | Gamification | Serious games
The rehabilitation of the mentally disabled in the community act in Israel: Entrepreneurship, leadership, and capitalizing on opportunities in policy making
بازسازی معلول ذهنی در عمل جامعه در اسرائیل: کارآفرینی، رهبری، و سرمایه گذاری در فرصت ها در سیاست گذاری-2019
This paper examines the role of policy entrepreneurs in the formation of a rehabilitation program in the field of mental health in Israel, shedding light on their role in general and specifically in mental health policy formation. Our research is based on a historical case study. The legislation process was examined through interviews with key actors in the legislative process and archival materials. While in general our findings reinforced existing literature, our research also revealed new information on several topics: organizations as policy entrepreneurs; inter-sectorial coalitions of entrepreneurs; and possible problems arising from the concept of ‘leadership by example.
Keywords: Policy formation | Policy entrepreneurs | Mental health policy | Mental health rehabilitation
Towards an accessible use of smartphone-based social networks through brain-computer interfaces
به سمت استفاده در دسترس از شبکه های اجتماعی مبتنی بر تلفن های هوشمند از طریق رابط های مغز و کامپیوتر-2019
This study presents an asynchronous P300-based Brain–Computer Interface (BCI) system for controlling social networking features of a smartphone. There are very few BCI studies based on these mobile devices and, to the best of our knowledge, none of them supports networking applications or are focused on an assistive context, failing to test their systems with motor-disabled users. Therefore, the aim of the present study is twofold: (i) to design and develop an asynchronous P300-based BCI system that allows users to control Twitter and Telegram in an Android device; and (ii) to test the usefulness of the developed system with a motor-disabled population in order to meet their daily communication needs. Row-col paradigm (RCP) is used in order to elicitate the P300 potentials in the scalp of the user, which are immediately processed for decoding the user’s intentions. The expert system integrates a decision-making stage that analyzes the attention of the user in real-time, providing a comprehensive and asynchronous control. These intentions are then translated into application commands and sent via Bluetooth to the mobile de- vice, which interprets them and provides visual feedback to the user. During the assessment, both quali- tative and quantitative metrics were obtained, and a comparison among other state-ofthe-art studies was performed as well. The system was tested with 10 healthy control subjects and 18 motor-disabled sub- jects, reaching average online accuracies of 92.3% and 80.6%, respectively. Results suggest that the system allows users to successfully control two socializing features of a smartphone, bridging the accessibility gap in these trending devices. Our proposal could become a useful tool within households, rehabilitation centers or even companies, opening up new ways to support the integration of motor-disabled people, and making an impact in their quality of life by improving personal autonomy and self-dependence.
Keywords: Brain-computer interface (BCI) | Smartphones | Asynchronous control | Social networks | P300 Event-related potentials | Electroencephalography (EEG)
Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management
تشخیص و درمان دیستروفی عضلانی دوچنانی، بخش 1: تشخیص و درمان عصبی-عضلانی، توانبخشی، غدد درون ریز و دستگاه گوارش و تغذیه-2018
Since the publication of the Duchenne muscular dystrophy (DMD) care considerations in 2010, multidisciplinary care of this severe, progressive neuromuscular disease has evolved. In conjunction with improved patient survival, a shift to more anticipatory diagnostic and therapeutic strategies has occurred, with a renewed focus on patient quality of life. In 2014, a steering committee of experts from a wide range of disciplines was established to update the 2010 DMD care considerations, with the goal of improving patient care. The new care considerations aim to address the needs of patients with prolonged survival, to provide guidance on advances in assessments and interventions, and to consider the implications of emerging genetic and molecular therapies for DMD. The committee identified 11 topics to be included in the update, eight of which were addressed in the original care considerations. The three new topics are primary care and emergency management, endocrine management, and transitions of care across the lifespan. In part 1 of this three-part update, we present care considerations for diagnosis of DMD and neuromuscular, rehabilitation, endocrine (growth, puberty, and adrenal insufficiency), and gastrointestinal (including nutrition and dysphagia) management.
Mining productive-periodic frequent patterns in tele-health systems
کاوش الگوهای تکراری دوره ای تولیدی در سیستم های بهداشت و درمان-2018
Recently, tele-health systems have gained attention from vast research fields because they facilitate remote monitoring of patients (e.g. vital sign data, physical activities, etc.) by utlizing various technologies such as body sensor network, wireless communications, multimedia and human-computer interactions without interrupting the quality of lifestyle. As tele-health generates a huge amount of healthcare data consisting of much useful information, finding hidden information from the data is an important task. The purpose of this work is to facilitate a real-time warning alarm in the context of tele-health remote monitoring using data mining techni ques. This can be utilized for the e-wellbeing applications, for example, rehabilitation, early identification of therapeutic issues and emergency warning. In particular, we focus on mining Productive Periodic frequent patterns from incremental databases (such as vital sign data of patients) for various decision makings. Exploring the correlations between periodic frequent vital sign data or items is important since the inherent relationships between the items of patterns are relevant. To mine the correlated periodic frequent patterns from incremental databases, we introduce the productive (i.e. useful) periodic frequent patterns (PPFP) as the set of periodic frequent patterns with periodicities that result from the occurrence of correlated items. We finally design and develop an efficient PPFP mining technique that can mine the complete set of useful periodically occurring patterns in incremental databases. Numerous experiments were performed on both real and synthetic data set to judge the effectiveness of the proposed pattern mining procedure when contrasted with existing best in class approaches.
Keywords: Tele-health ، Data mining ، Productive periodic frequent patterns ، Periodic patterns ، Incremental database ، Fp-growth
تاثیر تحریک زیرپوستی با جریان مستقیم روی کارکرد شناختی در بیماران سکته ای
سال انتشار: 2018 - تعداد صفحات فایل pdf انگلیسی: 8 - تعداد صفحات فایل doc فارسی: 20
پیش زمینه: اختلال شناختی پس از سکته، رایج و معمول است و می تواند باعث ایجاد ناتوانی شده و تاثیرات مهمی روی کیفیت زندگی و استقلال داشته باشد. تحریک زیرپوستی با جریان مستقیم می تواند بیانگر یک ابزار نویدبخش برای شکل گیری مجدّد کارکردهای شناختی در بیماران سکته ای باشد.
اهداف: هدف این مطالعه بررسی تاثیر تحریک زیرپوستی با جریان مستقیم روی کارکردهای شناختی در بیماران سکته ای می باشد.
بیماران و روشها: 40 بیمار سکته ای مرد مشمول این مطالعه شدند. بیماران به صورت تصادفی به دو گروه یکسان (A و B) تقسیم شدند. گروه A تحریک زیرپوستی با جریان مستقیم را در ترکیب با برنامه آموزشی شناختی انتخاب شده توسط رِهاکام (RehaCom) دریافت کرد. گروه B تحریک ساختگی زیرپوستی با جریان مستقیم را در ترکیب با همان برنامه آموزشی شناختی دریافت کرد. بررسی شناختی و سنجش استقلال کارکردی برای همه بیماران قبل و بعد از عمل تحریک انجام شد.
نتایج: یک بهبود قابل توجهی در نمرات توجه و تمرکز، حافظه ی شکلی، استدلال منطقی، رفتار واکنشی و رفتارهای پس از سنجش استقلال کارکردی در هردو گروه وجود داشت؛ این بهبود در گروه A در مقایسه با گروه B به صورت قابل توجهی بالاتر بود.
نتیجه گیری: تحریک زیرپوستی با جریان مستقیم یک روش توانبخشی عصبی موثر است که کارکردهای نامناسب شناختی پس از سکته را بهبود می بخشد. به علاوه، تحریک زیرپوستی با جریان مستقیم دارای یک تاثیر مثبت روی عملکرد فعالیتهای روزمره است.
کلیدواژه ها: سکته | تحریک زیرپوستی با جریان مستقیم | کارکردهای شناختی
|مقاله ترجمه شده|
An Adaptive Interface Design (AID) for enhanced computer accessibility and rehabilitation
طراحی رابط انطباق (AID) برای افزایش دسترسی به کامپیوتر و توانبخشی-2017
This study was aimed at the development of a non-intrusive, biosensor based, Adaptive Interface Design (AID) that utilizes its users physical abilities (rather than focusing on their disabilities), while simultaneously honoring their integrity and needs. The target users for this study were patients with arthritis in the hand. The AID comprises of eye tracking and data glove technologies, the latter of which will be used to measure the users physical ability as it translates hand gestures into computer controls. By developing accessible computer interfaces and exploring their use for telerehabilitation purposes, we want to ultimately impact the inclusion and health outcomes of those who experience disability on a daily basis.
Keywords:Adaptive Interface Design | Computer accessibility | Rehabilitation