Screening for Deep Vein Thrombosis in Persons With COVID-19 Upon Admission to an Inpatient Rehabilitation Hospital.

OBJECTIVE: The aim of the study was to determine the prevalence of deep venous thrombosis detected by duplex screening and risk factors associated with deep venous thrombosis in patients with COVID-19 upon admission to an inpatient rehabilitation hospital. DESIGN: This is a retrospective review. SETTING: The setting is three freestanding inpatient rehabilitation hospitals operating as one system. PARTICIPANTS: The participants are consecutive patients with a diagnosis of COVID-19 admitted to an inpatient rehabilitation hospital without a diagnosis of deep venous thrombosis or screening duplex ultrasound prior to transfer. INTERVENTIONS: A duplex ultrasound of lower limbs was performed upon admission to inpatient rehabilitation hospital. OUTCOME MEASURES: Primary outcome was the percentage of admission patients with a lower limb deep venous thrombosis. Secondary factors included potential risk factors for a positive screen for deep venous thrombosis. RESULTS: A lower limb deep venous thrombosis was diagnosed in 22% (25/113) of the patients tested, with eight patients (7.1%) having a proximal deep venous thrombosis. Risk factors for screening positive for a deep venous thrombosis included being male, younger, and having been on a ventilator during the acute illness. CONCLUSIONS: The high rate of deep venous thrombosis observed in these patients suggests that the risk of venous thromboembolic disorders after severe COVID-19 illness is considerable and surveillance measures of such patients should be undertaken.

Screening Testing for SARS-CoV-2 upon Admission to Rehabilitation Hospitals in a High COVID-19 Prevalence Community.

BACKGROUND: While planning for the care of coronavirus disease 2019 (COVID-19) patients during the pandemic crisis has dominated the focus of leaders of inpatient rehabilitation facilities (IRFs), patients with injuries/illnesses unrelated to COVID-19 continue to need inpatient rehabilitation admission. To maintain a safe environment for all patients and staff, we established an admission screening plan of testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to determine the presence of asymptomatic patients who were infected with the virus upon admission. OBJECTIVE: To determine the prevalence of patients who test positive for SARS-CoV-2 but were presumed to be COVID-19 negative at the time of admission to IRF in New Jersey. DESIGN: Retrospective analysis of SARS-CoV-2 testing results. SETTING: Four freestanding IRFs in New Jersey operated as one system. PATIENTS: All (N = 103) patients sequentially admitted from 4 to 27 April 2020 with no symptoms or evidence of COVID-19 disease at the time of transfer from the acute hospital. INTERVENTIONS: Specimens were collected for SARS-CoV-2 analysis at the time of admission to the IRF and patients were monitored for subsequent symptom development over the next 14 days. MAIN OUTCOME MEASURES: Results of SARS-CoV-2 testing upon admission and evidence of development of clinical signs or symptoms of COVID-19. RESULTS: Seven asymptomatic persons (6.8% of admissions) without clinical signs/symptoms of COVID-19 tested positive on admission. Of these, five developed symptoms of COVID-19, with a mean onset of 3.2 (range of 2-5) days. Five additional patients became symptomatic and tested positive within the next 3 to 10 days (mean of 5.2 days). Overall, 11.6% of admissions (12/103) had a positive test within 14 days of admission. CONCLUSIONS: Admission testing to postacute centers for SARS-CoV-2 can help identify presymptomatic or asymptomatic individuals, especially in areas where COVID-19 is prevalent. Negative results, however, do not preclude COVID-19 and should not be used as the sole basis for patient management decisions.

Prosthetics and orthotics for the older adult with a physical disability.

Prosthetics and orthotics serve many functions for the elderly and disabled. Assessment of patients in need of such devices is discussed. Prosthetic and orthotic devices are described with attention to their components, biomechanical effects, and potential value to patients. Strategies for selecting the proper device are presented. Structured rehabilitation is vital to ensure that patients maximally benefit from these devices; strategies for optimizing a rehabilitation program are discussed.

A combined treatment with D-amino acids and electroacupuncture produces a greater analgesia than either treatment alone; naloxone reverses these effects.

The D-amino acids (DAA), D-phenylalanine and D-leucine, produce naloxone reversible analgesia; electroacupuncture (EA) also produces analgesia which is blocked by naloxone. Combining the two treatments produces an additive effect with a larger analgesia than that produced by either treatment given alone; this combined effect is also blocked by naloxone. Moreover only 62% of the mice show EA analgesia and 53% show D-amino acid (DAA) analgesia; 80% of the animals show marked analgesia with both EA plus DAA treatment. Perhaps the combination of EA with DAA will provide a potent method for the treatment of clinical pain.