Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services.

OBJECTIVE: To identify nursing assessments of mobility and activity associated with lower-value rehabilitation services. DESIGN: Retrospective cohort analysis of admissions from December 2016 to September 2019 SETTING: Medicine, neurology, and surgery units (n=47) at a tertiary hospital. PARTICIPANTS: We included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients). INTERVENTIONS: Not applicable. MAIN OUTCOME: We examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit. MEASURES: Patient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or "6 clicks") inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting). RESULTS: Using an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults. CONCLUSIONS: Nursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs.

Development and Implementation of a New Model of Care for Patients With Stroke, Acute Hospital Rehabilitation Intensive SErvices: Leveraging a Multidisciplinary Rehabilitation Team.

ABSTRACT: The optimal timing and intensity of early rehabilitation remain uncertain. The literature has stated that too early high-intensity mobility within 24 hours can result in poor outcomes as compared with the 24- to 48-hour poststroke (Stroke 2012;43:2389-94. Stroke 2004;35:1005-9). However, few studies have shown that mobilizing patients a few times per day can have positive results (Stroke 2004;35:1005-9. Cerebrovasc Dis 2010;29:352-60). In addition to mobility impairments, many patients after stroke have dysphagia, aphasia, and cognitive-linguistic deficits. To date, there is limited literature on early rehabilitation in these areas. Here, we describe a program of enhanced rehabilitation in the acute care hospital. In this enhanced model of care, our team delivers up to six sessions of therapy per day focused on the patient's deficits. A patient can receive up to two sessions of each discipline daily to include physical therapy, occupational therapy, and speech language pathology. The model emphasizes team collaboration between therapy disciplines, physiatry, nursing, and neurology accomplished through a daily therapy schedule, rehabilitation huddle, and direct communication before and after therapy sessions. With this model, we aim to enhance coordination of care resulting in improved patient satisfaction and, ultimately, recovery.

Feasibility of an Enhanced Therapy Model of Care for Hospitalized Stroke Patients.

INTRODUCTION: The aim of this study was to determine the safety and feasibility of an enhanced therapy model for hospitalized stroke patients. METHODS: This was a quasi-experimental cohort study of acute stroke patients from a single hospital. In the intervention group, all hospitalized patients on the acute stroke service were seen by at least two therapy disciplines daily in addition to routine stroke care. The comparison group consisted of all patients admitted to the same stroke service 1 year before who received the standard of care. The primary endpoint was the number of completed therapy sessions. Exploratory endpoints compared the length of hospital stay, hospital readmission rates, and degree of disability measured by the 90-day modified Rankin Scale score. RESULTS: A total of 1110 records were analyzed with 553 subjects in the intervention group and 557 in the control group. The intervention group received a significantly higher number of therapy sessions. There was no significant difference in length of hospital stay. However, 30-day readmission rates were lower, and the percentage of patients who achieved a good functional outcome on the modified Rankin Scale was higher during the intervention period. CONCLUSION: Increasing exposure to intensive multidisciplinary therapy comparable with that of acute inpatient rehabilitation in the hospital setting is feasible and may reduce both readmission rates and disability.

Superstructure MOF as a framework to composite MoS2 with rGO for Li/Na-ion battery storage with high-performance and stability.

Metal sulfides, one kind of electrode material with very high theoretical capacity, have been widely studied for use in lithium and sodium ion batteries. However, there are some problems hindering their applications in electrodes, such as low conductivity and volume expansion. The MOF introduces metals with different coordination strengths into an existing MOF structure, which improves the performance of the electrode to a certain extent. In this paper, Fe/Zn bimetallic MOF rod-like superstructure was prepared based on Ostwald theory. Accompanied by sulfuration, the MOF was effectively combined with MoS2 and GO, and the objective materials Fe7S8-C/ZnS-C@MoS2/rGO composites were successfully prepared. The MOF material provides a good frame and an efficient electron transport path, while the robust rGO wall effectively inhibits the pulverization of materials during the lithium/sodium intercalation/escalation courses. This particular material exhibited excellent cycling and rate capability performance when used in Li/Na-ion batteries. When used in Li-batteries, the electrode material delivered a specific capacity of 1598.3 mA h g-1 at 0.1 A g-1 and remained at 1196.7 mA h g-1 even after about 100 cycles and further exhibited a specific capacity of 368.68 mA h g-1 at the current rate of 5 A g-1 even after 1000 cycles, respectively. As for sodium batteries, these electrode materials exhibited an initial reversible capacity of 1053.6 mA h g-1 at 0.1 A g-1 and the reversible capacity was still as high as 592.2 mA h g-1 after 200 cycles. It is perhaps that this composite material with its particular architecture and composition is greatly beneficial for electron transfer and Li/Na ion diffusion. In the repeated physicochemical/nutrifying process, the appropriate distance between adjacent MOFs is of great help in preventing volume changes and thus improving the electrochemical performance.

Mixed-Halide Perovskite Film-Based Neuromorphic Phototransistors for Mimicking Experience-History-Dependent Sensory Adaptation.

Sensory adaptation is an essential function for humans to live on the earth. Herein, a hybrid synaptic phototransistor based on the mixed-halide perovskite/organic semiconductor film is reported. This hybrid phototransistor achieves photosensitive performance including a high photoresponsivity over 4 × 103 A/W and an excellent specific detectivity of 2.8 × 1016 Jones. Due to the photoinduced halide-ion segregation of the mixed-halide perovskites and their slow recovery properties, the experience-history-dependent sensory adaptation behavior can be mimicked. Moreover, the light pulse width, intensity, light wavelength, and gate bias can be used to regulate the adaptation processes to improve its adaptability and perceptibility in different environments. The CsPbBrxI3-x/organic semiconductor hybrid films produced by spin coating are beneficial to large-scale fabrication. This study fabricates a novel solution-processable light-stimulated synapse based on inorganic perovskites for mimicking the human sensory adaptation that makes it possible to approach artificial neural sensory systems.

Weak Light-Stimulated Synaptic Hybrid Phototransistors Based on Islandlike Perovskite Films Prepared by Spin Coating.

An artificial synaptic device that can provide color discrimination, image storage, and image recognition is highly required to mimic the human vision for biological robots. All-inorganic halide perovskites have attracted extensive attention for the reason of their high stability and favorable photoelectric properties. In this study, a light-stimulated synaptic phototransistor based on a CsPbBr3/organic semiconductor hybrid film is reported. The fabricated CsPbBr3 film exhibits an island structure, which reduces the hysteresis effectively and at the same time achieves a high specific detectivity of up to 2 × 1015 Jones. The decay of the photocurrent can be delayed by changing the gate bias, which is essential for achieving high-performance light-stimulated synaptic devices. Due to the outstanding detectivity of the device, the obvious synaptic functions can be observed when triggered by a light signal with a power of 1.6 nW that is much weaker than previous most perovskite-based hybrid synaptic phototransistors under a low operating voltage of -1 V. The electrical power consumption of the device could be as low as 0.076 pJ when the power of light spike was 7.36 nW. Taking into account this characterization, with changing of light intensity or wavelength, the contrast of the image was enlarged, which can further promote the image recognition accuracy. More significantly, this CsPbBr3/TIPS hybrid film can be fabricated by facile and low-cost solution processes. This study indicates the great potential of solution-processed perovskite-based light-stimulated synapses for future artificial visual systems.

Prediction of Disposition Within 48 Hours of Hospital Admission Using Patient Mobility Scores.

Delayed hospital discharges for patients needing rehabilitation in a postacute setting can exacerbate hospital-acquired mobility loss, prolong functional recovery, and increase costs. Systematic measurement of patient mobility by nurses early during hospitalization has the potential to help identify which patients are likely to be discharged to a postacute care facility versus home. To test the predictive ability of this approach, a machine learning classification tree method was applied retrospectively to a diverse sample of hospitalized patients (N = 761) using training and validation sets. Compared with patients discharged to home, patients discharged to a postacute facility were older (median, 64 vs 56 years old) and had lower mobility scores at hospital admission (median, 32 vs 41). The final decision tree accurately classified the discharge location for 73% (95% CI, 67%-78%) of patients. This study emphasizes the value of systematically measuring mobility in the hospital and provides a simple decision tree to facilitate early discharge planning.

Ultrastable Quantum Dot Composite Films under Severe Environments.

Semiconductor quantum dots (QDs) have attracted extensive attention because of their remarkable optical and electrical characteristics. However, the practical application of QDs and further the QD composite films have greatly been hindered mainly owing to their essential drawbacks of extreme unstability under oxygen and water environments. Herein, one simple method has been employed to enhance enormously the stability of Cd xZn1- xSe yS1- y QD composite films by a combination of Cd xZn1- xSe yS1- y QDs and poly(vinylidene) fluoride (PVDF), which is characteristic of closely arranged molecular chains and strong hydrogen bonds. There are many particular advantages in using QD/PVDF composite films such as easy processing, low cost, large-area fabrication, and especially extreme stability even in the boiling water for more than 240 min. By employing K2SiF6:Mn4+ as a red phosphor, a prototype white light-emitting diode (WLED) with color coordinates of (0.3307, 0.3387), Tc of 5568 K, and color gamut 112.1NTSC(1931)% at 20 mA has been fabricated, and there is little variation under different excitation currents, indicating that the QD/PVDF composite films fabricated by this simple blade-coating process make them ideal candidates for liquid-crystal display backlight utilization via assembling a WLED on a large scale owing to its ultrahigh stability under severe environments.