Deconditioning Research Articles

Ending Pyjama Paralysis; Physical Steps In The Right Direction For An Irish University Hospital

Abstract Background The risk of hospital-associated deconditioning for frail older adults (i.e. reduced functional performance after acute hospitalisation, due to low activity levels during an admission) is well recognised, yet continues to occur commonly. This quality improvement project aimed to promote a cultural change within two acute medical wards, in line with the principles of “End PJ Paralysis”, which aims to “get patients out of bed, dressed in their own clothes and when possible, moving rather than lying in bed”. Methods A multidisciplinary committee was formed to oversee this project. An initial audit on observed levels of patient activity was performed, along with a root cause analysis to identify points of action. A multicomponent intervention was designed and implemented over an 8-week period (Oct to Nov 2023), with weekly re-audit of activity levels. Data on the monthly incidence of falls & pressure areas, as well as average length-of-stay, was also collected, with the results for the intervention period (Q4) compared with the monthly averages for the nine months prior (Q1-3). Results A total of 570 Patients were included. Improvements were observed in all outcomes. The proportion of patients dressed in their own clothes increased from 28.5% (18/63) to 51.8% (263/507), those sitting out in a chair increased from 50% (32/63) to 64% (326/507), and those mobilising at the time of audit increased from 60% (38/63) to 71% (360/507). Average falls (Q1-3 vs Q4) fell from 14.8 to 12.6 per month, average pressure sores from 5.5 to 5 per month, and average length of stay from 11.20 to 10 days. Conclusion This project demonstrates that a ward-based multidisciplinary initiative can lead to an increase in the proportion of patients on an acute medical ward being dressed in their own clothes, sitting out, and mobilising, without an increase in the incidence of falls.

Impact of the End PJ Paralysis interventions on patient health outcomes at the participating hospitals in Alberta, Canada

Purpose Multiple hospitals in Alberta implemented the End PJ Paralysis – a multicomponent inpatient ambulation initiative aimed at preventing the adverse physical and psychological effects patients experience due to low mobility during admission. To inform a scale-up strategy, this study assessed the impact of the initiative based on select process and outcome measures. Materials and methods Clinical and administrative data were obtained from the hospital Discharge Database, Research Electronic Data Capture (Redcaps), and Reporting and Learning System for Patient Safety. The variables explored were length of stay, inpatient falls, discharge disposition, pressure injury, patient ambulation, and patient dressed rates. We then used the Interrupted Time Series design for impact analysis. Results The analysis included discharge abstracts for 32,884 patients and the results showed significant improvements in outcomes at the participating units. The length of stay and inpatient falls were reduced immediately by 1.8 days (B2=-1.80, p = 0.044, 95% CI [-3.54, −0.05]), and 2.2 events (B2=-2.22, p = 005, 95% CI [-3.75, −0.69]). The percentage of patients discharged home increased overtime (B2=.39, p=.006, 95% CI [.11, .66]). Mobilization and dressed rates also improved. Conclusions The findings imply the interventions safely mitigated the risk of immobility-induced complications, including deconditioning and hospital-acquired disability.

The infrastructural conditions of (de-)growth: The case of the internet

Infrastructure studies represent a domain that remains significantly uncharted among degrowth scholars. This is paradoxical considering that infrastructures constitute a fundamental prerequisite for the equitable distribution of many aspects of human well-being that degrowth proponents emphasize. Nonetheless, the substantial resource and energy consumption associated with infrastructures cannot be overlooked. The internet offers an instructive case study in this sense, at its best it forges human connections and is productive of considerable societal value. The resource implications of the often-overlooked internet physical layer of data-centres and submarine cables needs to be acknowledged. Furthermore, the ways in which assumptions of perpetual growth are built into this global infrastructure via the logic layer of internet protocols and other governing mechanisms such as finance and network design need to be examined if we are to determine the extent to which such infrastructures are inherently growth dependent. In making these two arguments, we draw upon the work of both Science and Technology Studies (STS) and Large Technological System (LTS) studies on the inherent problems of large infrastructures which have thus far seen little engagement with questions of degrowth. We review the case of the internet and suggest a number of scenarios that illustrate potential roles for such infrastructures in any planned reduction of economic activity.

Histopathological survey of parasites harboured by the clam Tawera elliptica (Lamarck, 1818) from Chiloé Archipelago, southeastern Pacific

Tawera elliptica (commonly known as “Almeja Juliana”, is a venerid clam that inhabits sandy bottoms and is distributed from Valparaíso on the Pacific coast up to the Mar del Plata area along the Atlantic coast. Harvests of this clam have declined substantially over the last decade. Therefore, an analysis of common parasites and pathological conditions of this clam was undertaken along with histopathology. Monthly samples were prepared for routine histology for examination under light and electron microscopy. T. elliptica has a sex ratio of 1:1 and the relationship between the shell length and the wet tissue weight is not significantly different between females and males. The maximum values for de condition index and meat yield were found during the austral winter. The following parasites (and their overall prevalence) were detected: intracellular microcolonies of bacteria in digestive gland (22.9%), intestinal epithelium (9.3%) and gills (3.17%), an unidentified cyst in gills (59,3%), a Steinhausia-like intraoocytic microsporidian (5.2%), Gregarine spores (41.3%), ciliated protozoa (16.7%), two metazoa, a Paravortex like flatworm (4.3%), and a digenean trematode (8%). The monthly mean intensity of the most relevant parasites was between 2.3 and 35.6 for digestive gland intracellular microcolonies of bacteria (IMC), 0–5.1 for intestinal epithelium IMC, 0–2 for branchial IMC and 0 – 48 for intraoocytic microsporidium. The prevalence and the infection intensity were low-to very low, and no World Organisation for Animal Health OIE listed parasite was detected. It is concluded that this is a healthy clam, and no disease risks for the cultivation are visualized at present. However, IMC at high prevalence and intensities of infection could be potentially impactful, and the intraoocytic microsporidian could jeopardize reproduction if present in high intensities of infection.

Hospital Induced Deconditioning

Medicine is considered to be one of the most noble as well as premium profession. We love saving lives each day and cherish a deep sense of accomplishment in what we do. However, the experience of being in a hospital is quite different from a patient’s perspective, and I hope to talk more about the impact here.

108 A Multidisciplinary Team Initiative to End PJ Paralysis Was Successful in Achieving Cultural Change on An Acute Geriatric Ward

IntroductionProlonged bedrest amongst the elderly causes deconditioning leading to; increased hospital length of stay, additional social costs and decreased quality of life. An audit on an acute geriatric ward in November 2018, found that over a third of patients medically fit (PMF) to sit out remained in bed all day. Therefore, a service development initiative was undertaken, addressing the misconception that keeping elderly patients in bed is safe, when in fact, unintentional harm results.MethodIn a root cause analysis, four main reasons for bedrest were identified: risk aversion, unknown function, widespread “bed is safe” culture and lack of equipment. The project tasked getting PMF out of bed each day and was audited daily from November 2018 to present, involving all members of the multi-disciplinary team (MDT) and using a “plan, do, study, act” approach.ResultsInitially, the project showed an increase in percentage of PMF sitting out each day, but this subsequently decreased with winter pressures. However, for a whole year (February 2019–February 2020) a sustained and significant improvement was achieved (64.3%–89.7%). The pre-COVID19 period (February–March 2020) saw fluctuations in PMF sitting out. Data collection halted during the COVID19 peak, although observationally most patients remained in bed. Auditing resumed from June 2020 (COVID19 recovery phase) which showed a steady increase in PMF out of bed, with recent figures surpassing pre-COVID19 levels (97.8%).ConclusionCultural change takes time to embed and needs persistent reviewing by a dedicated and engaged MDT. Improvements were made through more accessible doctor’s advice, better MDT education and communication, daily feedback of data and sourcing additional equipment. Disruption to working patterns over the COVID19 period made this unachievable and the project lost impetus. In the COVID19 recovery phase, the specialized MDT reformed and worked successfully to restore the cultural change as evidenced by audited data.

Evaluation of the Impact of Doppler Effect on Quality of HSR Radiocommunications

The article proposes a methodology for evaluating radio signal distortions caused by Doppler effect (DE; also, Doppler shift) under the conditions of highspeed train traffic (HSR, high-speed rail). The objective of the work is to develop criteria for assessing quality of radiocommunications with moving objects in HSR environment. For this, a technique is proposed for calculating the probability of an error arising from Doppler effect. A rationale for relevance of the topic is that radiocommunications are used on railways for controlling train traffic and ensuring safety and achieving required quality of radio signals is a major challenge. Quality assessment is especially important for organization of broadband communication channels with locomotive drivers using mobile networks. To solve this problem, a model for assessing quality of radiocommunication influenced by DE is considered. Distortions of signals in a radio channel due to DE are proposed to be estimated using the reduced dispersion of the total error, which consists of two components: dynamic and interference. Calculations of the total reduced signal error and the error probability for speeds above 100 km/h are described. Estimates of the effect of DE on a coherent receiver, in which errors may occur due to changes in duration of radio pulses, are suggested. Effectiveness of the receiver’s automatic frequency control (AFC) system is analysed as a means of challenging DE. For this, the concept of an instantaneous spectrum of parasitic frequency modulation due to DE was introduced and quality of radio communication was calculated using the reduced dispersion of the total error. The efficiency of using AFC has been proven after comparing the evaluations of reception quality with and without AFC in the form of the ratio of error probabilities. The features of the use of mobile communications on railways under the conditions of DE are formulated.

Move groove improve quality improvement project

Purpose: The purpose of this project was to reduce the effects of deconditioning and promote functional independence on an elderly care ward, with the ethos inspired by the End Pj Paralysis campaign. The first aim was for over 55% of patients to be sitting out daily for lunch on the ward. The aim was also for over 20% of patients to be wearing their own clothes daily on the ward. Secondary aims including improving patient experience, increasing staff knowledge on deconditioning and maintaining and reducing length of stay.

Inpatient and home-based rehabilitation regimen after COVID-19 illness

The severe acute respiratory coronavirus-2 syndrome infection has spread worldwide and has an abrupt effect on human, economic, and health system. The data are collected from various relevant sources such as PubMed, Infection Prevention Control, World Health Organization novel coronavirus disease (COVID-19) situation update report, Australian and New Zealand Intensive Care Society guidelines, Society of Critical Care Medicine, World Confederation for Physical therapy guidelines, and from other Internet sources. It is observed that about 30% of COVID-19 patients with sepsis needed hospital rehabilitation, while 20% requires a home-based rehabilitation program. Based on the evidence, it is anticipated that severe and critical COVID-19 patients develop postintensive care syndrome, resulting in pulmonary disabilities, dyspnea on exertion, physical deconditioning, cognitive impairment, and mental health disturbances. Most of these symptoms may also occur in patients recovered from symptoms, or who were not admitted to intensive care unit, or in older adults with chronic health conditions, or who have been deconditioned due to mobility disability, social isolation, etc. Such patients need access to effective pulmonary therapy, functional rehabilitation, and stress management in the hospital- and home-based settings to regain their previous independence level. The evidence suggests that viruses could even survive in the oropharyngeal cavity and stool for up to 15 days after COVID-19 infection has been declared cured. The physiotherapist must take proper safety measures before managing patients at home; a virtual care therapy is therefore highly recommended. Due to the increasing demands of hospital beds, the patients may need to be discharged earlier than expected. Rehabilitation act as adjuvant therapy in preparing patients for discharges, reducing the experience of disability, and ensuring the quality of treatment among recovered/discharged COVID-19 patients in hospital- or home-based settings.

235 Pyjama Paralysis: Time to Make a Move!

Abstract Background The adverse effects of inpatient falls are well known. The harms of unwarranted bedrest and prolonged immobilisation present insidiously but, arguably, have a greater impact. Deconditioning, itself, is a major contributor to falls in older adults. There is still a troubling assumption that falls can be prevented through restraint and preventing at-risk patients from mobilising. Methods We reviewed medical and nursing notes and conducted brief-structured interviews with nurses and brief bedside observations for medical inpatients aged ≥75. We constructed a research template based on the UK National Falls audit 20151 and the Hospital Elder Life Program (HELP) - mobility toolkit2. We included all patients on medical wards over the age of 75, admitted for 3 or more days. We excluded patients who were critically unwell or imminently dying. Results We reviewed 100 medical inpatients aged over 75. Patients’ mobility deteriorated significantly from their baseline, with 73% of patients requiring assistance compared to 22% at baseline. PJ paralysis was endemic with only one third of patients wearing day clothes. 75% of patients spent more than half of the day in bed. There were 8 falls during the entire study period. Poorer levels of mobility correlated with delirium and incontinence. Conclusion The deleterious effects on older patient of the traditional model of acute hospital care with gratuitous bedrest are universally acknowledged. Falls should be prevented through supervision rather than restraint. Campaigns such as “End PJ Paralysis” and the HELP mobility toolkit can enable a cultural change within hospitals. Such change is impossible without the staffing and leadership to endorse it.

135 The Impact of an Early Mobilisation Initiative Evidence from an Acute Care Setting

Abstract Background Unnecessary bed rest results in a loss of mobility and an increased length of hospital stay. Despite mobilising regularly being acknowledged as an important preventative measure for deconditioning, inpatient functional decline continues to pose a significant challenge in hospital settings. Hospital-based mobility initiatives offer the potential to address issues of functional decline, improve patient outcomes and hospital length of stay. The aim of this research is to examine the impact of an early mobilisation initiative called “End PJ Paralysis”. Methods The research design comprises of three elements: (i) an examination of a period that promoted mobility to all patients on one acute unit (ii) an analysis of the reported number of falls during the study period and (iii) an exploration of perceptions and attitudes of nurses, nurse managers, and patients involved with the initiative. Results Our study demonstrates that following a 10-week promotion of the initiative from April 17th-June 26th 2018 in an acute care setting in south of Ireland, an increase of 15% of patients were mobilising and a decrease in the number of reported falls. In addition, staff participation was found to increase and self-reported patient satisfaction improved. Factors identified as influencing the impact of the initiative included patient and staff behavior, nurse management leadership, and effective communication. Conclusion The study provides evidence to suggest that early mobilisation initiatives can prevent deconditioning and improve patient outcomes. Each day a patient spends in hospital should contribute towards their recovery and discharge and mobilising patients while in hospital has a profound impact on their functional status.

Changes and interactions of physical activity in patients with occupational respiratory diseases after a behavioral exercise intervention: A study protocol

Introduction: An active lifestyle represents a challenge for patients with chronic respiratory diseases because of pathophysiological alterations which lead to reduced physical activity (PA). Patients fall into a downward spiral of deconditioning with increased symptoms and reduced PA. Various studies suggest that a higher PA level in these subjects increases quality of life and reduces risk of hospital admissions and mortality, so that the long-term maintenance of PA in these patients is an important aim in disease management. As ordinary fitness training during inpatient rehabilitation seems to be insufficient, behavior changes promise long-term success. Methods and analysis: The objective of this longitudinal analysis is to investigate various physiological and psychological determinants of PA in patients with occupational respiratory diseases. The randomized controlled trial will examine the effects of a behavioral exercise intervention during inpatient pulmonary rehabilitation (PR) on the basis of objective (by ActigraphGT3x+®) and subjective physical activity measured 4 weeks before the start of the rehabilitation and 2, 6 and 12 months after rehabilitation. In addition, psychological determinants such as anxiety, depression and self-efficacy, will be investigated. Participants were randomized in an intervention group (IG) and control group (CG). The IG participated in a behavioral exercise intervention of 9 sessions, in addition to the regular PR. The CG received standard PR over 4 weeks. The behavioral exercise intervention is based on a theoretical framework of various behavior change models in order to maintain or increase PA with the help of volitional and motivational strategies including knowledge transfer, goal setting, action planning and barrier management. Every session consists of theoretical and practical elements to enable participants to pursue an active lifestyle. Conclusion: The purpose of the current study (a randomized controlled trial) is to examine the effectiveness of a behavioral exercise intervention during an inpatient rehabilitation of patients with occupational respiratory diseases on several outcomes, for example, physical activity and mental health. Thus, the results will contribute to optimize a sustainable disease management.

Optimization of preventive maintenance for series manufacturing system by differential evolution algorithm

The costs of preventive maintenance have been extensively studied by scholars across all preventive optimization model disciplines. However, one phenomenon fails to be fully studied: breakdown and breakdown maintenance costs. We set out to fill this gap in this study. This study considered the cost of equipment preventive maintenance, and the breakdown maintenance cost caused by an accidental breakdown. In order to more accurately establish the reliability model of equipment breakdown, the three-parameter Weibull distribution was applied to set up the reliability model of equipment and the differential evolution algorithm was adopted to optimize the parameters. On this basis, preventive maintenance was regarded as imperfect maintenance in the study of preventive maintenance strategies for single equipment. In consideration of the combined influence of preventive maintenance and breakdown maintenance, a maintenance strategy in which preventive maintenance times N served as the decision variable was obtained to build a mathematical model on benefit expectation of single equipment in unit time. Based on the research of single equipment, a further study was performed on the multi-equipment series system. Moreover, two strategies were given, both of which use preventive maintenance times N as the decision variable. The first strategy is to take the average cost rate of the system under long-term operation as the optimization objective, while the second strategy is to apply single component maintenance strategy in series system. In the numerical example study, a series manufacturing system composed of two devices was chosen as the research object. Interestingly, we discussed the effect of initial conditions of two-parameter DE on output results. After acquiring the optimal initialization parameters, the failure rate function was achieved by the DE to estimate the parameters of three-parameter Weibull distribution. Meanwhile, the maintenance times N was optimized according to the two strategies respectively. The best result were selected from the results of both strategies based on availability. Thus, the validity and practicability of the proposed research methods are verified.

Letter to the Editor: Selecting the best measure for hospital-acquired deconditioning

Letter to the Editor: Selecting the best measure for hospital-acquired deconditioning

Dichoptic Attentive Motion Tracking is Biased Toward the Nonamblyopic Eye in Strabismic Amblyopia.

To determine whether attention is biased toward the nonamblyopic eye under binocular viewing conditions in adults with anisometropic or strabismic amblyopia. We first determined whether attention could be allocated preferentially to one eye in visually normal observers performing a dichoptic attentive motion tracking task. We then assessed dichoptic attentive motion tracking in amblyopia. Participants performed a multiple-object tracking task under the following three viewing conditions: target dots to the dominant eye and distractor dots to the nondominant eye (DE condition), vice versa (NDE condition), or all dots to both eyes (binocular condition). Interocular attentional asymmetry scores were computed as the difference in accuracy between DE and NDE conditions. An interocular contrast difference favoring the amblyopic eye was used for all conditions to neutralize amblyopic eye suppression. To test for confounding effects of suppression, participants completed a separate dot enumeration task under dichoptic presentation conditions to obtain an interocular enumeration asymmetry score. Participants with normal vision demonstrated similar accuracy between the DE and NDE conditions and exhibited slightly impaired performance under dichoptic compared with binocular viewing conditions. Participants with strabismic/mixed amblyopia had significantly higher interocular attentional asymmetry than participants with normal vision or with anisometropic amblyopia, whereby attention was biased toward the nonamblyopic eye. The latter two groups did not exhibit a bias in interocular attention. No interocular asymmetries for the enumeration task were observed for any group. A nonamblyopic eye bias in the interocular allocation of attention may contribute to the binocular vision impairments caused by strabismic amblyopia.

Do Economic Sanctions Stop Building Nuclear Weapons : Case Studies on the Conditions of (De)nuclearization upon Sanctions of the United States

Do Economic Sanctions Stop Building Nuclear Weapons : Case Studies on the Conditions of (De)nuclearization upon Sanctions of the United States

46Staff Members’ Perceptions of the “End PJ Paralysis” Initiative

46Staff Members’ Perceptions of the “End PJ Paralysis” Initiative

Staff urged to get patients up and dressed in bed to end PJ paralysis

Staff urged to get patients up and dressed in bed to end PJ paralysis

Chief nursing officer launches national campaign on ‘PJ paralysis’

Chief nursing officer launches national campaign on ‘PJ paralysis’

'PJ paralysis' campaign gets patients up and trusts moving.

The aims of the #EndPJparalysis campaign are simple: get patients out of bed and dressed during the day, and then into chairs, activity rooms or to dining rooms for meals. Increased activity can help recovery, reduce muscle wastage, maintain independence and lead to patients being discharged sooner.