The role of payment sources in the continuation of rehabilitation therapy in tertiary hospitals for patients with traumatic spinal cord injury: a study in Southwest China.

Medical security support for rehabilitation therapy in China is different from that in other countries. We investigated whether the discharge plan to continue rehabilitation therapy in tertiary hospitals for patients after traumatic spinal cord injury (TSCI) was influenced by payment sources or other conditions. This was a cross-sectional, observational study. Information was collected on the general condition, caregiver, types of payment sources for continued rehabilitation, American Spinal Injury Association Impairment Scale (AIS) scores, and discharge plans. In total, 135 patients with TSCI (107 male, mean age 41.00 ± 13.73 years, mean spinal cord injury duration 238.43 ± 345.54 days) were enrolled. Medical insurance (43%) and out-of-pocket payments (27.4%) were the primary payment sources. Although most patients were beyond the acute phase, 40% continued rehabilitation therapy at other tertiary hospitals. The caregiver, payment sources, injury level, AIS level, and complete urinary tract infection (UTI) were different due to discharge plans (p > .05). Patients seemingly consider a higher AIS level and co-UTI as the requirement for tertiary hospital therapy. In non-medical insurance payment source patients, the discharge plan also differed due to the AIS level and co-UTI (p > .05). However, in medical insurance patients, the discharge plan differed only in terms of TSCI duration (p > .05). The restricted duration of medical coverage restricted the continuation of rehabilitation therapy and influenced the discharge plan of most patients with TSCI.

Nomograms for the prediction of decannulation in patients with neurological injury: a study based on clinical practice.

BACKGROUND: Rational prediction of the probability of decannulation in tracheotomy patients is of great importance to clinicians and patients' families. This study aimed to develop a prediction model for decannulation in tracheotomized patients with neurological injury using routine clinical data and blood tests. METHODS: We developed a prediction model based on 186 tracheotomized patients, and data were collected from January 2018 to March 2021. The least absolute shrinkage and selection operator (LASSO) regression model was used to optimize feature selection for the decannulation risk model. The performance of the prediction model was evaluated in terms of discrimination, calibration, and clinical utility using measures such as C-index, calibration plot, and decision curve analysis (DCA). Internal validation was performed through bootstrapping validation. RESULTS: A total of 66.13% (123/186) of patients were decannulated. Predictors included in the prediction nomogram were age, gender, subtype of neurological injury, Glasgow Coma Scale (GCS) score, swallowing function, duration of tracheotomy, procalcitonin (PCT) level, white blood cell (WBC) count, and serum albumin (ALB) level. The predictive model showed good discrimination, with a C-index of 0.755 (95% confidence interval: 0.68-0.83). Internal validation also confirmed a satisfactory C-index of 0.690. The DCA indicated that the nomogram added substantial value in predicting decannulation risk for patients with threshold probabilities falling between >21% and <98% compared to the existing scheme. CONCLUSIONS: This predictive model serves as a valuable instrument for clinicians to quantitatively assess the probability of decannulation in patients with neurological injury, aiding in informed decision-making and patient management.

Current status of rehabilitation services and problems in Yunnan Province, Southwest China: a general doctors' questionnaire-based study.

OBJECTIVES: Community-based hospitals in China lack physicians, especially rehabilitation physicians. Recently, several financial resources have been developed to prepare general doctors for community-based hospitals. These doctors seem to be the best choices for assuming the role of a rehabilitation physician. However, their willingness and in-depth information from their perspectives have not been previously investigated. MATERIALS AND METHODS: We conducted a general investigation of rehabilitation resources in Yunnan, a province located in Southwest China with a population of more than 40 million. Our investigation covered the entire Yunnan Province from December 2020 to May 2022. The questionnaire was administered to 670 general doctors in 112 community hospitals randomly selected in Yunnan Province based on their willingness to assume the role of rehabilitation physicians and obstructive factors to process the rehabilitation services. The reliability and validity of the questionnaire were evaluated, and items regarding their general condition were analyzed. RESULTS: Cronbach's alpha and Kaiser-Meyer-Olkin values were 0.748 and 0.729, respectively. The measure comprises four factors: common disease, demand for training to improve skills, subjective/objective factors, and proactivity to recommend rehabilitation therapy. More than 20% of general doctors were unwilling to take on the role of rehabilitation physicians, and their willingness was related to satisfaction with their current job, comprehension of community-based rehabilitation, and comprehension of government support (p < .05). CONCLUSIONS: From the perspective of general doctors, the reimbursement rate for medical insurance, which burdens patients, is the greatest problem in the process of developing community-based hospital rehabilitation services. Offering professional training to increase their capacity and developing common practices to increase doctors' proactivity to recommend rehabilitation therapy may help increase the future support of medical insurance and increase general doctors' willingness to take on the role of a rehabilitation physician.

Post-stroke cognitive impairment: A bibliometric and knowledge-map analysis.

BACKGROUND: Post-stroke cognitive impairment (PSCI) has a negative effect on activities of daily living. OBJECTIVE: Although a number of studies have been published on PSCI, no quantitative studies have yet been conducted. METHOD: CiteSpace and VOSviewer were used to quantitatively analyze PSCI to illustrate the research hotspots and trends in PSCI. All relevant publications were extracted from the Science Citation Index Expanded (SCI-E) of the Web of Science (WoS). RESULTS: A total of 6536 articles were included in this study. From 349 in 2010 to 942 in 2020, the number of publications increased dramatically. The USA maintained the top position worldwide and provided a vital influence. Harvard University was considered the leader in research collaboration among all institutions. Stroke was the most popular journal in this sector and Vincent Mok published the most articles in this area. We analyzed the keywords and identified five research hotspot clusters. By summarizing the literature on PSCI, we considered the publication information regarding different countries, institutions, authors and journals. CONCLUSION: The mechanism of PSCI is an active hotspot. Cerebral vascular disease, especially white matter lesions, also received more attention.

Validation of the cognitive performance scale of the interRAI-PAC and montreal cognitive assessment.

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).