Development and Validation of a Decision Tree Analysis Model for Predicting Home Discharge in a Convalescent Ward: A Single Institution Study.

OBJECTIVES: Accurately predicting the likelihood of inpatients' home discharge in a convalescent ward is crucial for assisting patients and families in decision-making. While logistic regression analysis has been commonly used, its complexity limits practicality in clinical settings. We focused on decision tree analysis, which is visually straightforward. This study aimed to develop and validate the accuracy of a prediction model for home discharge for inpatients in a convalescent ward using a decision tree analysis. METHODS: The cohort consisted of 651 patients admitted to our convalescent ward from 2018 to 2020. We collected data from medical records, including disease classification, sex, age, duration of acute hospitalization, discharge destination (home or nonhome), and Functional Independence Measure (FIM) subitems at admission. We divided the cohort data into training and validation sets and developed a prediction model using decision tree analysis with discharge destination as the target and other variables as predictors. The model's accuracy was validated using the validation data set. RESULTS: The decision tree model identified FIM grooming as the first single discriminator of home discharge, diverging at four points and identifying subsequent branching for the duration of acute hospitalization. The model's accuracy was 86.7%, with a sensitivity of 0.96, specificity of 0.52, positive predictive accuracy of 0.88, and negative predictive accuracy of 0.80. The area under the receiver operating characteristic curve was 0.75. CONCLUSION: The predictive model demonstrated more than moderate predictive accuracy, suggesting its utility in clinical practice. Grooming emerged as a variable with the highest explanatory power for determining home discharge.

Association of life-space with light-intensity and moderate to vigorous-intensity physical activity in older adults using daycare rehabilitation facilities.

BACKGROUND: The use of assistive devices and the presence of caregivers in the living space of older people using daycare rehabilitation facilities may increase their physical activity. However, the exact relationship between these factors and physical activity has not been well established. OBJECTIVE: We aimed to examine whether assistive devices and caregivers were life-space factors associated with light-intensity physical activity (LPA) and moderate to vigorous-intensity physical activity (MVPA) among daycare rehabilitation facility users. METHODS: Forty-seven daycare rehabilitation facility users were recruited (mean age: 76.5 ± 8.6 years; men: 16; women: 31). LPA and MVPA were measured using accelerometers and averaged over 7 days. Life-space assessment (LSA) and the Geriatric Depression Scale score were assessed. The LSA includes composite life-space, maximal life-space (LS-M), life-space using equipment (LS-E), and independent life-space. Grip strength and maximum gait speed were measured two times, and the best results were used. RESULTS: Multiple regression analysis showed that LPA was significantly associated with sex (ß = 0.773), grip strength (ß = 0.434), and LS-M (ß = 0.325), whereas MVPA was significantly associated with age (ß = -0.421) and LS-E (ß = 0.455). CONCLUSION: A close association was found between LS-M and LS-E and the intensity of physical activity in older people who used daycare rehabilitation facilities.

Effects of task-specific paretic ankle plantar flexor training on walking in a stroke patient: a single-case study.

[Purpose] The purpose of this study was to examine the effects of task-specific plantar flexor training on walking ability indices in a patient with a paretic ankle. [Subject and Methods] The subject was a 65-year-old male patient with right hemiplegia due to a left medullary ventral infarction. An ABA' single-subject design was adopted. The independent variable was a task-specific plantar flexor training exercise, similar to that during walking, targeting the paretic ankle. The dependent variables were the isometric ankle plantar flexor strength, maximum walking speed, step length, and trailing limb angle in the paretic terminal stance phase. The B study phase was divided into B1 and B2 phases. A two standard-deviation-band method was used to evaluate improvement. [Results] Improvements in the paretic plantar flexor strength, maximum walking speed, step length, and trailing limb angle in the B2 phase were observed. The improvements in the maximum walking speed, step length, and trailing limb angle were sustained in the A' study phase. [Conclusion] These results suggest that task-specific plantar flexor training exercise is efficacious in improving the walking ability index of a paretic ankle.

Characterization of a homologue of mammalian serine racemase from Caenorhabditis elegans: the enzyme is not critical for the metabolism of serine in vivo.

Free d-serine (d-Ser) plays a crucial role in regulating brain function in mammals. In various organisms, including mammals, d-Ser is biosynthesized by Ser racemase, a synthetic enzyme that produces d-Ser from l-Ser. Ser racemase also exhibits dehydratase activity toward several hydroxyamino acids. Thus, this enzyme is unique in that it possesses the capability to both synthesize and degrade d-Ser; however, the physiological significance of its degradative activity remains unclear. In contrast to the physiological roles of d-Ser in mammals, little is known about the role of this amino acid in lower organisms, including the nematode Caenorhabditis elegans. It is known that a mammalian Ser racemase homologue (T01H8.2) from C. elegans exhibits racemase activity. Here, the enzymatic properties of recombinant T01H8.2 were characterized and compared with those of recombinant human Ser racemase. Furthermore, the levels of several d- and l-amino acids were measured in wild-type C. elegans and in a mutant in which the T01H8.2 gene is partially deleted and thereby inactivated. The results indicate that T01H8.2 also shows dehydratase activity toward several hydroxyamino acids, although the enzyme is not critical for Ser metabolism in vivo. The possible physiological roles of T01H8.2 are discussed.

Effects of isokinetic passive exercise and isometric muscle contraction on passive stiffness.

[Purpose] The purpose of this study was to investigate the effects of isokinetic passive exercise and motion velocity on passive stiffness. In addition, we also discuss the effects of the contraction of agonist and antagonist muscles on passive stiffness. [Subjects] The subjects were 20 healthy men with no bone or joint disease. [Methods] Isokinetic passive exercise and isometric muscle contraction were performed on an isokinetic dynamometer. The angular acceleration measured by the accelerometer was compared before and after each task. [Results] After the passive exercise, the angular acceleration increased in the phase of small damped oscillation. Moreover, the effect was higher at high-speed movement. The angular acceleration was decreased by the contraction of the agonist muscle. Conversely, the angular acceleration was increased by the contraction of the antagonist muscle. [Conclusion] Isokinetic passive exercise reduced passive stiffness. Our results suggest the possibility that passive stiffness is increased by agonist muscle contraction and decreased by antagonist muscle contraction.