Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care.

The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising. However, further research, policy advocacy, and practice analysis must be undertaken to promote and protect adequate access to occupational therapy and physical therapy in SNFs and other PAC settings. Individual practitioners must participate in data gathering to ensure that the data for analysis are fully informed by the occupational therapy perspective.

Hepcidin/Ferritin Quotient Helps to Predict Spontaneous Recovery from Iron Loss following Blood Donation.

BACKGROUND: Iron supplementation is generally recommended for blood donors even though there are inter-individual differences in iron homeostasis. METHODS: Ferritin levels of repeat donors were compared with first-time donors, retrospectively. Prospectively, we tested 27 male repeat donors for the following parameters at the day of blood donation as well as 1, 3, 7, 10, and 56 days thereafter: ferritin, hepcidin, transferrin, transferrin receptor, hemoglobin, erythropoietin, reticulocytes, hemoglobin in reticulocyte, twisted gastrulation protein homolog 1, and growth differentiation factor-15. RESULTS: 56 days after blood donation, donors' average ferritin dropped to 55% (range 30-100%) compared to the initial value. Of all tested parameters hepcidin showed the highest and most significant changes beginning 1 day after donation and lasting for the whole period of 56 days. Along with ferritin, there was a high variation in hepcidin levels indicating inter-individual differences in hepcidin response to iron loss. Donors with a hepcidin/ferritin quotient < 0.3 regained 60% of their initial ferritin after 56 days, while those with a quotient ≥ 0.3 reached less than 50%. CONCLUSION: As hepcidin appears to integrate erythropoietic and iron-loading signals, clinical measurement of hepcidin (together with the hepcidin-ferritin ratio) may become a useful indicator of erythropoiesis and iron kinetics.

Multimodal image-guided prostate fusion biopsy based on automatic deformable registration.

PURPOSE: Transrectal ultrasound (TRUS)-guided random prostate biopsy is, in spite of its low sensitivity, the gold standard for the diagnosis of prostate cancer. The recent advent of PET imaging using a novel dedicated radiotracer, [Formula: see text]-labeled prostate-specific membrane antigen (PSMA), combined with MRI provides improved pre-interventional identification of suspicious areas. This work proposes a multimodal fusion image-guided biopsy framework that combines PET-MRI images with TRUS, using automatic segmentation and registration, and offering real-time guidance. METHODS: The prostate TRUS images are automatically segmented with a Hough transform-based random forest approach. The registration is based on the Coherent Point Drift algorithm to align surfaces elastically and to propagate the deformation field calculated from thin-plate splines to the whole gland. RESULTS: The method, which has minimal requirements and temporal overhead in the existing clinical workflow, is evaluated in terms of surface distance and landmark registration error with respect to the clinical ground truth. Evaluations on agar-gelatin phantoms and clinical data of 13 patients confirm the validity of this approach. CONCLUSION: The system is able to successfully map suspicious regions from PET/MRI to the interventional TRUS image.