A post-diagnosis information and support programme for dyads-People living with dementia or mild cognitive impairment and family carers: A feasibility study.

AIM: The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings. DESIGN: A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility. METHODS: Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators. RESULTS: Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members. CONCLUSION: Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months. IMPACT: This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting. REPORTING METHOD: The authors have adhered to the EQUATOR STROBE Statement. PATIENT OR PUBLIC CONTRIBUTION: A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation.

Semi-supervised ROC analysis for reliable and streamlined evaluation of phenotyping algorithms.

OBJECTIVE: High-throughput phenotyping will accelerate the use of electronic health records (EHRs) for translational research. A critical roadblock is the extensive medical supervision required for phenotyping algorithm (PA) estimation and evaluation. To address this challenge, numerous weakly-supervised learning methods have been proposed. However, there is a paucity of methods for reliably evaluating the predictive performance of PAs when a very small proportion of the data is labeled. To fill this gap, we introduce a semi-supervised approach (ssROC) for estimation of the receiver operating characteristic (ROC) parameters of PAs (eg, sensitivity, specificity). MATERIALS AND METHODS: ssROC uses a small labeled dataset to nonparametrically impute missing labels. The imputations are then used for ROC parameter estimation to yield more precise estimates of PA performance relative to classical supervised ROC analysis (supROC) using only labeled data. We evaluated ssROC with synthetic, semi-synthetic, and EHR data from Mass General Brigham (MGB). RESULTS: ssROC produced ROC parameter estimates with minimal bias and significantly lower variance than supROC in the simulated and semi-synthetic data. For the 5 PAs from MGB, the estimates from ssROC are 30% to 60% less variable than supROC on average. DISCUSSION: ssROC enables precise evaluation of PA performance without demanding large volumes of labeled data. ssROC is also easily implementable in open-source R software. CONCLUSION: When used in conjunction with weakly-supervised PAs, ssROC facilitates the reliable and streamlined phenotyping necessary for EHR-based research.

A Systematic Study on Impact of Binder Formulation on Green Body Strength of Vat-Photopolymerisation 3D Printed Silica Ceramics Used in Investment Casting.

Additive ceramics manufacturing with vat-photopolymerisation (VP) is a developing field, and the need for suitable printing materials hinders its fast growth. Binder mixtures significantly influence the mechanical properties of printed ceramic bodies by VP, considering their rheological properties, curing performances and green body characteristics. Improving mechanical characteristics and reducing cracks during printing and post-processes is mainly related to binder formulations. The study aims to develop a binder formulation to provide the printed ceramic specimens with additional green strength. The impact on mechanical properties (ultimate tensile strength, flexural strength, Young's and strain at breakpoint), viscosity and cure performance of Urethane Acrylate (UA) and thermoplastic Polyether Acrylate (PEA) oligomers to monofunctional N-Vinylpyrrolidone (NVP), 1,6-Hexanediol Diacrylate (HDDA) and Tri-functional Photocentric 34 (PC34) monomers were investigated under varying concentrations. The best mechanical characteristic was showcased when the PC34 was replaced with 20-30 wt.% of UA in the organic medium. The Thermogravimetric Analysis (TGA) and sintering test outcomes revealed that increasing the content of NVP in the organic medium (above 15 wt.%) leads to uncontrolled thermal degradation during debinding and defects on ceramic parts after sintering. The negative effect of UA on the viscosity of ceramic-loaded mixtures was controlled by eliminating the PC34 compound with NVP and HDDA, and optimum mechanical properties were achieved at 15 wt.% of NVP and 65 wt.% of HDDA. PEA is added to provide additional flexibility to the ceramic parts. It was found that strain and other mechanical parameters peaked at 15 wt.% of PEA. The study formulated the most suitable binder formulation on the green body strength of printing silica ceramics as 50 wt.% HDDA, 20 wt.% Urethane Acrylate, 15 wt.% NVP and 15 wt.% PEA.

Fitting and validation of an agent-based model for COVID-19 case forecasting in workplaces and universities.

COVID-19 forecasting models have been critical in guiding decision-making on surveillance testing, social distancing, and vaccination requirements. Beyond influencing public health policies, an accurate COVID-19 forecasting model can impact community spread by enabling employers and university leaders to adapt worksite policies and practices to contain or mitigate outbreaks. While many such models have been developed for COVID-19 forecasting at the national, state, county, or city level, only a few models have been developed for workplaces and universities. Furthermore, COVID-19 forecasting models have rarely been validated against real COVID-19 case data. Here we present the systematic parameter fitting and validation of an agent-based compartment model for the forecasting of daily COVID-19 cases in single-site workplaces and universities with real-world data. Our approaches include manual fitting, where initial model parameters are chosen based on historical data, and automated fitting, where parameters are chosen based on candidate case trajectory simulations that result in best fit to prevalence estimation data. We use a 14-day fitting window and validate our approaches on 7- and 14-day testing windows with real COVID-19 case data from one employer. Our manual and automated fitting approaches accurately predicted COVID-19 case trends and outperformed the baseline model (no parameter fitting) across multiple scenarios, including a rising case trajectory (RMSLE values: 2.627 for baseline, 0.562 for manual fitting, 0.399 for automated fitting) and a decreasing case trajectory (RMSLE values: 1.155 for baseline, 0.537 for manual fitting, 0.778 for automated fitting). Our COVID-19 case forecasting model allows decision-makers at workplaces and universities to proactively respond to case trend forecasts, mitigate outbreaks, and promote safety.

Machine learning approaches for electronic health records phenotyping: a methodical review.

OBJECTIVE: Accurate and rapid phenotyping is a prerequisite to leveraging electronic health records for biomedical research. While early phenotyping relied on rule-based algorithms curated by experts, machine learning (ML) approaches have emerged as an alternative to improve scalability across phenotypes and healthcare settings. This study evaluates ML-based phenotyping with respect to (1) the data sources used, (2) the phenotypes considered, (3) the methods applied, and (4) the reporting and evaluation methods used. MATERIALS AND METHODS: We searched PubMed and Web of Science for articles published between 2018 and 2022. After screening 850 articles, we recorded 37 variables on 100 studies. RESULTS: Most studies utilized data from a single institution and included information in clinical notes. Although chronic conditions were most commonly considered, ML also enabled the characterization of nuanced phenotypes such as social determinants of health. Supervised deep learning was the most popular ML paradigm, while semi-supervised and weakly supervised learning were applied to expedite algorithm development and unsupervised learning to facilitate phenotype discovery. ML approaches did not uniformly outperform rule-based algorithms, but deep learning offered a marginal improvement over traditional ML for many conditions. DISCUSSION: Despite the progress in ML-based phenotyping, most articles focused on binary phenotypes and few articles evaluated external validity or used multi-institution data. Study settings were infrequently reported and analytic code was rarely released. CONCLUSION: Continued research in ML-based phenotyping is warranted, with emphasis on characterizing nuanced phenotypes, establishing reporting and evaluation standards, and developing methods to accommodate misclassified phenotypes due to algorithm errors in downstream applications.

Characterization of Temperature-Dependent Kinetics of Oculocutaneous Albinism-Causing Mutants of Tyrosinase.

Human tyrosinase (Tyr) is a glycoenzyme that catalyzes the first and rate-limiting step in melanin production, and its gene (TYR) is mutated in many cases of oculocutaneous albinism type 1 (OCA1). The mechanisms by which individual mutations contribute to the diverse pigmentation phenotype in patients with OCA1 have only began to be examined and remain to be delineated. Here, we analyze the temperature-dependent kinetics of wild-type Tyr (WT) and two OCA1B mutant variants (R422Q and P406L) using Michaelis-Menten and Van't Hoff analyses. Recombinant truncated human Tyr proteins (residues 19-469) were produced in the whole insect Trichoplusia Ni larvae. Proteins were purified by a combination of affinity and size-exclusion chromatography. The temperature dependence of diphenol oxidase protein activities and kinetic parameters were measured by dopachrome absorption. Using the same experimental conditions, computational simulations were performed to assess the temperature-dependent association of L-DOPA and Tyr. Our results revealed, for the first time, that the association of L-DOPA with R422Q and P406L followed by dopachrome formation is a complex reaction supported by enthalpy and entropy forces. We show that the WT has a higher turnover number as compared with both R422Q and P406L. Elucidating the kinetics and thermodynamics of mutant variants of Tyr in OCA1B helps to understand the mechanisms by which they lower Tyr catalytic activity and to discover novel therapies for patients.

A holistic approach for suppression of COVID-19 spread in workplaces and universities.

As society has moved past the initial phase of the COVID-19 crisis that relied on broad-spectrum shutdowns as a stopgap method, industries and institutions have faced the daunting question of how to return to a stabilized state of activities and more fully reopen the economy. A core problem is how to return people to their workplaces and educational institutions in a manner that is safe, ethical, grounded in science, and takes into account the unique factors and needs of each organization and community. In this paper, we introduce an epidemiological model (the "Community-Workplace" model) that accounts for SARS-CoV-2 transmission within the workplace, within the surrounding community, and between them. We use this multi-group deterministic compartmental model to consider various testing strategies that, together with symptom screening, exposure tracking, and nonpharmaceutical interventions (NPI) such as mask wearing and physical distancing, aim to reduce disease spread in the workplace. Our framework is designed to be adaptable to a variety of specific workplace environments to support planning efforts as reopenings continue. Using this model, we consider a number of case studies, including an office workplace, a factory floor, and a university campus. Analysis of these cases illustrates that continuous testing can help a workplace avoid an outbreak by reducing undetected infectiousness even in high-contact environments. We find that a university setting, where individuals spend more time on campus and have a higher contact load, requires more testing to remain safe, compared to a factory or office setting. Under the modeling assumptions, we find that maintaining a prevalence below 3% can be achieved in an office setting by testing its workforce every two weeks, whereas achieving this same goal for a university could require as much as fourfold more testing (i.e., testing the entire campus population twice a week). Our model also simulates the dynamics of reduced spread that result from the introduction of mitigation measures when test results reveal the early stages of a workplace outbreak. We use this to show that a vigilant university that has the ability to quickly react to outbreaks can be justified in implementing testing at the same rate as a lower-risk office workplace. Finally, we quantify the devastating impact that an outbreak in a small-town college could have on the surrounding community, which supports the notion that communities can be better protected by supporting their local places of business in preventing onsite spread of disease.

Neutrophil Enzyme Myeloperoxidase Modulates Neuronal Response in a Model of Subarachnoid Hemorrhage by Venous Injury.

Background and Purpose: Aneurysmal subarachnoid hemorrhage (SAH) is associated with the development of delayed cognitive deficits. Neutrophil infiltration into the central nervous system is linked to the development of these deficits after SAH. It is however unclear how neutrophil activity influences central nervous system function in SAH. The present project aims to elucidate which neutrophil factors mediate central nervous system injury and cognitive deficits after SAH. Methods: Using a murine model of SAH and mice deficient in neutrophil effector functions, we determined which neutrophil effector function is critical to the development of deficits after SAH. In vivo and in vitro techniques were used to investigate possible pathways of neutrophils effect after SAH. Results: Our results show that mice lacking functional MPO (myeloperoxidase), a neutrophil enzyme, lack both the meningeal neutrophil infiltration (wild type, sham 872 cells/meninges versus SAH 3047, P=0.023; myeloperoxidase knockout [MPOKO], sham 1677 versus SAH 1636, P=NS) and erase the cognitive deficits on Barnes maze associated with SAH (MPOKO sham versus SAH, P=NS). The reintroduction of biologically active MPO, and its substrate hydrogen peroxide (H2O2), to the cerebrospinal fluid of MPOKO mice at the time of hemorrhage restores the spatial memory deficit observed after SAH (time to goal box MPOKO sham versus MPOKO+MPO/H2O2, P=0.001). We find evidence of changes in neurons, astrocytes, and microglia with MPO/H2O2 suggesting the effect of MPO may have complex interactions with many cell types. Neurons exposed to MPO/H2O2 show decreased calcium activity at baseline and after stimulation with potassium chloride. Although astrocytes and microglia are affected, changes seen in astrocytes are most consistent with inflammatory changes that likely affect neurons. Conclusions: These results implicate MPO as a mediator of neuronal dysfunction in SAH through its effect on both neurons and glia. These results show that, in SAH, the activity of innate immune cells in the meninges modulates the activity and function of the underlying brain tissue.

Tyrosinase Nanoparticles: Understanding the Melanogenesis Pathway by Isolating the Products of Tyrosinase Enzymatic Reaction.

Human Tyrosinase (Tyr) is the rate-limiting enzyme of the melanogenesis pathway. Tyr catalyzes the oxidation of the substrate L-DOPA into dopachrome and melanin. Currently, the characterization of dopachrome-related products is difficult due to the absence of a simple way to partition dopachrome from protein fraction. Here, we immobilize catalytically pure recombinant human Tyr domain (residues 19-469) containing 6xHis tag to Ni-loaded magnetic beads (MB). Transmission electron microscopy revealed Tyr-MB were within limits of 168.2 ± 24.4 nm while the dark-brown melanin images showed single and polymerized melanin with a diameter of 121.4 ± 18.1 nm. Using Hill kinetics, we show that Tyr-MB has a catalytic activity similar to that of intact Tyr. The diphenol oxidase reactions of L-DOPA show an increase of dopachrome formation with the number of MB and with temperature. At 50 °C, Tyr-MB shows some residual catalytic activity suggesting that the immobilized Tyr has increased protein stability. In contrast, under 37 °C, the dopachrome product, which is isolated from Tyr-MB particles, shows that dopachrome has an orange-brown color that is different from the color of the mixture of L-DOPA, Tyr, and dopachrome. In the future, Tyr-MB could be used for large-scale productions of dopachrome and melanin-related products and finding a treatment for oculocutaneous albinism-inherited diseases.

Transforming Psychiatry into Data-Driven Medicine with Digital Measurement Tools.

Psychiatry has been limited by historically rooted practices centered primarily on subjective observation. Fields such as oncology have progressed toward data-driven clinical decision-making that combines subjective clinical assessment of symptoms and preferences with biological measures such as genetics, biomarkers, imaging, and integrative physiology to derive quantitative risk scores and decision support. In contrast, psychiatry has just begun to scratch the surface of measurement-based care with validated clinical questionnaires. An opportunity exists to improve modern psychiatric care with novel data streams from digital sensors combined with clinical observation and subjective self-report. The prospect of integrating this complex information with modern computational and analytical methods could advance the field, both in research and clinical practice. Here we discuss this possibility and propose some key priorities to enable these innovations toward improving clinical outcomes in the future.

Reliability of an Online Geriatric Assessment Procedure Using the interRAI Acute Care Assessment System.

OBJECTIVES: To determine whether geriatric triage decisions made using a comprehensive geriatric assessment (CGA) performed online are less reliable than face-to-face (FTF) decisions. DESIGN: Multisite noninferiority prospective cohort study. Two specialist geriatricians assessed individuals sequentially referred for an acute care geriatric consultation. Participants were allocated to one FTF assessment and an additional assessment (FTF or online (OL)), creating two groups-two FTF (FTF-FTF, n = 81) or online and FTF (OL-FTF, n = 85). SETTING: Three acute care public hospitals in two Australian states. PARTICIPANTS: Admitted individuals referred for CGA. INTERVENTION: Nurse-administered CGA, based on the interRAI Acute Care assessment system accessed online and other online clinical data such as pathology results and imaging enabling geriatricians to review participants' information and provide input into their care from a distance. MEASUREMENTS: The primary decision subjected to this analysis was referral for permanent residential care. Geriatricians also recorded recommendations for referrals and variations for medication management and judgment regarding prognosis at discharge and after 3 months. RESULTS: Overall percentage agreement was 88% (n = 71) for the FTF-FTF group and 91% (n = 77) for the OL-FTF group. The difference in agreement between the FTF-FTF and OL-FTF groups was -3%, indicating that there was no difference between the methods of assessment. Judgements made regarding diagnoses of geriatric syndromes, medication management, and prognosis (with regard to hospital outcome and location at 3 months) were found to be equally reliable in each mode of consultation. CONCLUSION: Geriatric assessment performed online using a nurse-administered structured CGA system was no less reliable than conventional assessment in making clinical triage decisions.

Gait outcomes of older adults receiving subacute hospital rehabilitation following orthopaedic trauma: a longitudinal cohort study.

OBJECTIVES: This study aimed to describe gait speed at admission and discharge from inpatient hospital rehabilitation among older adults recovering from orthopaedic trauma and factors associated with gait speed performance and discharge destination. DESIGN: A longitudinal cohort study was conducted. SETTING: Australian tertiary hospital subacute rehabilitation wards. PARTICIPANTS: Patients aged ≥60 years recovering from orthopaedic trauma (n=746, 71% female) were eligible for inclusion. INTERVENTIONS: Usual care (multidisciplinary inpatient hospital rehabilitation). PRIMARY AND SECONDARY OUTCOME MEASURES: Gait speed was assessed using the timed 10 m walk test. The proportion of patients exceeding a minimum gait speed threshold indicator (a priori 0.8 m/s) of community ambulation ability was calculated. Generalised linear models were used to examine associations between patient and clinical factors with gait speed performance and being discharged to a residential aged care facility. RESULTS: At discharge, 18% of patients (n=135) exceeded the 0.8 m/s threshold indicator for community ambulation ability. Faster gait speed at discharge was found to be associated with being male (B=0.43, 95% CI -0.01 to 0.87), admitted with pelvic (B=0.76, 95% CI 0.14 to 1.37) or multiple fractures (B=1.13, 95% CI 0.25 to 2.01) (vs hip fracture), using no mobility aids (B=-0.93, 95% CI -1.89 to 0.01) and walking at a faster gait speed at admission (B=5.77, 95% CI 5.03 to 6.50). Factors associated with being discharged to residential aged care included older age (OR 1.06, 95% CI 1.03 to 1.10), longer length of stay (OR 1.01, 95% CI 1.01 to 1.02), having an upper limb fracture (vs hip fracture) (OR 2.81, 95% CI 1.32 to 5.97) and lower Functional Independence Measure cognitive score (OR 0.89, 95% CI 0.86 to 0.92). CONCLUSIONS: Patients with a range of injury types, not only those presenting to hospital with hip fractures, are being discharged with slow gait speeds that are indicative of limited functional mobility and a high risk of further adverse health events.

Understanding and managing the risk of "head impact" from in-hospital falls: A cross-sectional analysis of data from 166 public hospitals.

BACKGROUND: Falls are a leading cause of preventable harm in the hospitalized elderly, and head impacts (HIs) can be a precursor to serious injury. The aim of this study was to examine if the risk of fall-related HI can be explained by incident characteristics. METHODS: All reported falls across public hospital facilities in the state of Queensland, Australia, over a 2-year period were analyzed using univariate and multiple logistic regression. RESULTS: In all, 650 instances of HI were reported across 24 218 falls. Falls due to fainting were associated with elevated HI odds (odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.30, 3.08). Similarly, falls while walking (OR = 1.48, 95% CI = 1.20, 1.81) and falls during certain time periods, namely, from 11:00 pm to midnight (OR = 1.79, 95% CI = 1.24, 2.59) and between 5:00 am and 6:00 am (OR = 1.50, 95% CI = 1.01, 2.22) were linked to increased HI odds. Falls among males were associated with lowered odds of HI (adjusted odds ratio [AOR] = 0.78, 95% CI = 0.64, 0.74). CONCLUSIONS: Results confirm links between characteristics of inpatient falls and the likelihood of HI, and these data can assist risk managers to better target fall prevention strategies. Assisted mobility in high-risk patients and improved environmental lighting are advanced as foci for future research.

Using Care Bundles to Improve Surgical Outcomes and Reduce Variation in Care for Fragility Hip Fracture Patients.

INTRODUCTION: Fragility hip fractures constitute a large proportion of orthogeriatric admissions to orthopedic wards. This study looked at reducing variation in care in fragility hip fracture patients using a novel approach with care bundles. The care bundle comprises 5 elements targeted at providing adequate analgesia, early mobilization, improving recognition of delirium, and decreasing rates of urinary infections. METHODS: A total of 198 patients who sustained a fragility hip fracture during the intervention period were included in the study. The primary outcome measure was compliance in applying the bundle to the study population, and secondary outcome measures were in-hospital mortality, acute length of stay, delirium and duration of delirium, and urinary tract infections. RESULTS: During the 12-month intervention period, compliance to the bundle of care was 47% (n = 92) based on the "all-or-none" approach. This was 28% higher than the preintervention rate. Overall, there was an increased rate of compliance across all individual elements of the bundle in the intervention group when compared to the preintervention group (P = .01). The most significant clinical result was a 10.5% reduction in "in-hospital mortality" in the intervention group (P < .001). CONCLUSION: This study demonstrated that the implementation of specific care bundle in patients with fragility hip fracture significantly reduces variation in care.

Web-based (online) comprehensive geriatric assessment is more time efficient, and as reliable, as reading patient medical records and conducting traditional in person consultations.

The aim of this study was to report the time taken by geriatricians to reach triage decisions using an online assessment format compared with face-to-face (FTF) assessment. Patients (N = 166) were randomly allocated to two groups: online and FTF assessments (OF group); and dual FTF assessments (FF group). Case preparation was conducted by trained nurse assessors using a web-enabled clinical decision support system. Geriatricians allocated to perform an 'online' assessment had access to this information only. Geriatricians allocated FTF assessments reviewed this data, as well as the paper-based medical file and then consulted directly with the patient and attending staff. Data were collected in relation to time taken to complete OL assessments, compared with FTF assessments. A complete OL consultation averages 10 minutes, and a FTF consultation almost 26 minutes. In FTF consultations, less time is spent using the OL material when the geriatrician is aware that they will have access to the patient chart and need time to speak with the patient. The less time taken using the OL approach did not significantly alter the triage decisions made by the geriatricians.

Evidence of Improved Efficiency in Functional Gains During Subacute Inpatient Rehabilitation.

This comparative study investigated differences in functional capacity and functional gains of patients admitted for hospital rehabilitation between 2005 and 2011. Patients were grouped according to broad diagnostic categories: neurological, orthopedic, and deconditioned. Functional capacity (Functional Independence Measure (FIM), gait speed) and functional gains were compared between two 1-year patient cohorts (2005 and 2011) for diagnostic groups. In 2011, more patients were admitted (n = 626 vs. n = 474) with a shorter length of stay (mean difference 9.72 days, 95% confidence interval (CI) 5.26 to 14.18) compared to 2005. Functional capacity of patients at admission was worse in 2011 for all measures (P < 0.05). By hospital rehabilitation discharge, no differences were found between the two cohorts (P > 0.497) except for discharge gait speed; in 2011, patients walked faster (mean difference 0.58 m/s, 95% CI 0.05 to 0.11). Higher FIM gain and FIM efficiency was demonstrated in 2011, but differences between diagnostic groups were evident. Deconditioned patients overall demonstrated less gain and efficiency (F > 3.623, P < 0.028). In summary, improved service efficiencies were demonstrated with improved throughput of patients without compromising functional capacity at hospital rehabilitation discharge. These efficiencies seem to be gained through neurological and orthopedic admissions compared to deconditioned admissions.

Patients undergoing subacute physical rehabilitation following an acute hospital admission demonstrated improvement in cognitive functional task independence.

OBJECTIVE: This study investigated cognitive functioning among older adults with physical debility not attributable to an acute injury or neurological condition who were receiving subacute inpatient physical rehabilitation. DESIGN: A cohort investigation with assessments at admission and discharge. SETTING: Three geriatric rehabilitation hospital wards. PARTICIPANTS: Consecutive rehabilitation admissions (n = 814) following acute hospitalization (study criteria excluded orthopaedic, neurological, or amputation admissions). INTERVENTION: Usual rehabilitation care. MEASUREMENTS: The Functional Independence Measure (FIM) Cognitive and Motor items. RESULTS: A total of 704 (86.5%) participants (mean age = 76.5 years) completed both assessments. Significant improvement in FIM Cognitive items (Z-score range 3.93-8.74, all P < 0.001) and FIM Cognitive total score (Z-score = 9.12, P < 0.001) occurred, in addition to improvement in FIM Motor performance. A moderate positive correlation existed between change in Motor and Cognitive scores (Spearman's rho = 0.41). Generalized linear modelling indicated that better cognition at admission (coefficient = 0.398, P < 0.001) and younger age (coefficient = -0.280, P < 0.001) were predictive of improvement in Motor performance. Younger age (coefficient = -0.049, P < 0.001) was predictive of improvement in FIM Cognitive score. CONCLUSIONS: Improvement in cognitive functioning was observed in addition to motor function improvement among this population. Causal links cannot be drawn without further research.