Initiation Of Rehabilitation Research Articles

Clinical Prediction Rule for Identifying the Stroke Patients who will Obtain Clinically Important Improvement of Upper Limb Motor Function by Robot-Assisted Upper Limb

BackgroundThe number of studies on the characteristics of patients with stroke who would benefit from robot-assisted upper limb rehabilitation is limited, and there are no clear criteria for determining which individuals should receive such treatment. The current study aimed to develop a clinical prediction rule using machine learning to identify the characteristics of patients with stroke who can the achieve minimal clinically important difference of the Fugl-Meyer Upper Extremity Evaluation (FMA-UE) after single-joint hybrid assistive limb (HAL-SJ) rehabilitation. MethodsThis study included 71 patients with subacute stroke who received HAL-SJ rehabilitation. The chi-square automatic interaction detector (CHAID) model was applied to predict improvement in upper limb motor function. Based the analysis using CHAID, age, sex, days from stroke onset to the initiation of HAL-SJ rehabilitation, and upper limb motor and cognitive functions were used as independent variables. Improvement in upper limb motor function was determined based on the minimal clinically important difference of the FMA-UE, which was used as a dependent variable. ResultsAccording to the CHAID model, the FMA-UE score during the initiation of HAL-SJ rehabilitation was the most significant predictive factor for patients who are likely to respond to the intervention. Interestingly, this therapy was more effective in patients with moderate upper limb motor dysfunction and early initiation of HAL-SJ rehabilitation. The accuracy of the CHAID model was 0.89 (95% confidence interval: 0.81–0.96). ConclusionWe developed a clinical prediction rule for identifying the characteristics of patients with stroke whose upper limb motor function can improve with HAL-SJ rehabilitation.

Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study.

BackgroundDespite the widespread practice of nerve-sparing robot-assisted radical prostatectomy (nsRARP) for the treatment of localized prostate cancer (PCa), erectile dysfunction remains a significant sequela of radical prostatectomy.AimThis study aimed to compare the efficacy of tadalafil 5 mg once daily for erectile function recovery in patients who underwent nsRARP according to the timing of rehabilitation initiation.MethodsIn this double-blind, prospective pilot study, a total of 41 patients who underwent nsRARP were randomly assigned into 2 groups according to the timing of rehabilitation initiation. In the preRARP group (n = 20), tadalafil was started 2 weeks before nsRARP, and in the postRARP group (n = 21), it was started 4 weeks after nsRARP. Erectile function recovery after nsRARP was defined as an International Index of Erectile Function (IIEF-5) score of ≥17.OutcomesThe measures of EF recovery were the changes in IIEF-5 score.ResultsThe rate of erectile function recovery at 12-month follow-up was 80.0% and 71.4% in the preRARP and postRARP groups, respectively. The mean differences between baseline and postoperative IIEF-5 scores at 1-, 3-, 6-, and 12-month follow-up were −11.7 ± 3.2, −7.4 ± 3.2, −5.6 ± 1.5, and −4.1 ± 1.1 in the preRARP group and −14.7 ± 4.7, −12.0 ± 5.0, −9.7 ± 3.9, and −6.0 ± 3.1 in the postRARP group, respectively (1-month, P = .259; 3-months, P = .077; 6-months, P = .014; 12-months, P = .007).Clinical implicationsPreoperative tadalafil 5 mg once a day could be used effectively and safely as a strategy for penile rehabilitation after nsRARP.Strengths and LimitationsThis study is the first prospective trial of penile rehabilitation with tadalafil 5 mg once a day prior to nsRARP. This is a pilot study with the limitations of a small sample; further and large-scale studies with multiple cohorts, such as an untreated control group and an early immediate rehabilitation group for EF recovery, are needed.ConclusionThis study suggests that preoperative penile rehabilitation using tadalafil may lead to better erectile function recovery than postoperative penile rehabilitation using tadalafil.Noh T, Shim JS, Kang SG, et al. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med 2022;10:100508.

Concomitant Total Shoulder Arthroplasty and Ipsilateral Carpal Tunnel Release: Is It Safe?

Symptomatic carpal tunnel syndrome in patients with advanced ipsilateral glenohumeral arthritis requiring total shoulder arthroplasty (TSA) may be easily overlooked. Even when diagnosed beforehand, most upper extremity surgeons have historically chosen to perform TSA and carpal tunnel release (CTR) separately. We hypothesized that combined single-stage TSA and CTR is feasible and yields results comparable with those when the 2 procedures are performed separately, while avoiding 2 surgeries. This was a retrospective review of patients who underwent single-stage primary TSA and ipsilateral CTR between 2015 and 2019. The shoulder outcomes included pain, range of motion, and validated quality of life (QoL) questionnaires: Veterans RAND 12-Item Health Survey (VR-12) and Penn Shoulder Score. The CTR outcomes included pain, grip, pinch, VR-12, shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH), and Boston Carpal Tunnel Questionnaire. The time to the initiation of rehabilitation and complications were also analyzed. The comparison group consisted of patients who underwent independent TSA or CTR during the same period. Forty-one patients underwent concomitant TSA and CTR, 248 underwent isolated TSA, and 154 underwent isolated CTR. The shoulder outcomes of patients who underwent the combined procedure were similar to those of patients who underwent isolated TSA in terms of pain, range of motion, general QoL (VR-12), and shoulder-specific QoL (Penn Shoulder Score). The outcomes of patients who underwent the combined procedure were similar to those of patients who underwent isolated CTR in terms of pain, grip and pinch, general QoL (VR-12), QuickDASH, and Boston Carpal Tunnel Questionnaire. The time to the initiation of rehabilitation was also comparable. Concomitant CTR and TSA are feasible. The functional outcomes and QoL of patients who underwent the concomitant treatment were comparable with those of patients who underwent the 2 procedures separately. Therapeutic IV.

Acute-Phase Initiation of Cardiac Rehabilitation for Short-Term Improvement in Activities of Daily Living in Patients Hospitalized for Acute Heart Failure.

Background: Whether acute-phase cardiac rehabilitation (CR) is beneficial for short-term improvement in activities of daily living (ADL) in patients hospitalized for acute heart failure (AHF) remains unclear. Aim: To investigate the association of acute-phase initiation of CR with short-term improvement in ADL in patients hospitalized for AHF. Methods: We retrospectively analyze data from the Diagnosis Procedure Combination Database, a nationwide inpatient database. Patients hospitalized for HF between January 2010 and March 2018 are included. Propensity score matching and generalized linear models are built to examine the association between improvement in ADL and acute-phase CR initiation, defined as the initiation of CR within two days of admission. Results: Among 306,826 eligible patients, CR is initiated in 45,428 patients (14.8%) within two days of hospital admission. Propensity score matching creates 45,427 pairs. CR initiation within two days of hospital admission is associated with ADL improvement (risk ratio: 1.018; 95% confidence interval: 1.004–1.032), particularly in elderly patients, females, and individuals with low ADL at admission, body mass index of 18.5–24.9 kg/m2, and New York Heart Association class IV. Conclusions: Our analyses highlight the possibility that acute-phase CR initiation may result in short-term improvement in ADL in patients hospitalized for AHF.

Binocular vision parameters in chronic heavy alcoholics: Short-term outcomes of alcohol detoxification

Background: Alcohol consumption is rising in developing countries such as India, and alcohol addiction has systemic and ocular impacts. This study aimed to investigate the binocular functions of chronic heavy alcoholics before and after alcohol detoxification.
 Methods: A prospective before–after study was designed and conducted at Treda De-Addiction Centre, Bengaluru, India. Males in the age range of 30–40 years who had been alcohol addicts for more than six years and met the inclusion criteria were recruited. We performed a routine optometric examination followed by detailed binocular vision assessment, including accommodative, vergence, and oculomotor tests on the first day of rehabilitation and one month after initiation of rehabilitation.
 Results: Twenty-five males with of the age (mean ± standard deviation [SD]) 36.24 ± 4.33 years were evaluated. The pre- and post-detoxification mean ± SD of the monocular (right eye: 5.98 ± 3.50, 6.60 ± 3.49; left eye: 6.18 ± 3.69, 7.10 ± 3.78) and binocular accommodative facility (7.10 ± 3.93, 7.40 ± 4.51) did not change significantly (all P > 0.05). Eighteen (72%) of the participants had non-strabismic binocular vision anomalies (NSBVA), among whom the accommodative infacility and convergence insufficiency were higher in frequency and remained constant after alcohol detoxification. Furthermore, the binocular vision parameters showed no statistically significant difference between the pre- and post-detoxification values (all P > 0.05).
 Conclusions: The binocular vision parameters did not change significantly after one month of alcohol detoxification in the chronic heavy drinkers. Most long-term alcoholics had NSBVA with no change after rehabilitation, indicating that short-term alcohol detoxification may not aid in the recovery of binocular parameters. However, further validation is required. Assessing the impact of vision therapy in addition to a longer period of abstinence can confirm or refute the persistence of observed effects of chronic alcohol consumption on binocular functions and NSBVA in this population.

Effects and influencing factors of vestibular rehabilitation in 171 cases

Objective: To explore the effect of vestibular rehabilitation and to identify factors that can affect rehabilitation outcomes. Methods: From December 2018 to October 2020, patients who underwent vestibular rehabilitation in the Eye, Ear, Nose and Throat Hospital of Fudan University were prospectively followed up. A battery of vestibular function examinations and psychological status evaluations were applied before and after rehabilitation initiation. The main outcomes were vertigo/dizziness and unsteadiness, measured by visual analogue scale (VAS); Secondary outcomes were daily activities and participation, assessed by vestibular activities and participation measure (VAP). Paired t-test was used to compare the effects before and after rehabilitation. Binary logistic regressions were applied to analyze the influencing factors of rehabilitation outcomes. Results: A total sample of 171 patients was followed up regularly with a median time of 11 months. Of the 171 patients evaluated, 72 were males and 99 were females; age ranged from 10 to 89 years old with a median age of 55 years old. At 6-month follow-up, the difference of VAS score of vertigo/dizziness and unsteadiness pre-post rehabilitation was 1.79±1.80 and 1.56±1.76, respectively; The difference of activity and participation domain of VAP score was 2.51±13 and 1.27±3.75, respectively. All differences pre-post rehabilitation exhibited statistically significant with P values<0.01. Regression analysis demonstrated that the length of symptom onset was a significant predictor of poor balance recovery (OR=6.52; 95%CI:2.10, 20.27). Visual dependence (OR=5.44; 95%CI: 1.38, 21.47) and suspectable anxiety (OR=6.45; 95%CI: 1.49, 28.30) were identified as risk factors for poor recovery of vertigo/dizziness. Conclusions: Vestibular rehabilitation effectively reduces dizziness, promotes balance, and improves the function of daily activities. Time from the onset, visual dependence and suspectable anxiety are the main factors hindering a desirable rehabilitation outcome.

Optimisation of postoperative X-ray acquisition for orthopaedic patients.

Postoperative X-rays are a key part of management of orthopaedic patients. These X-rays serve to check stability of orthopaedic fixation as well as to ensure that there are no peri-implant fractures and periprosthetic fractures following surgical fixation of fractures and arthroplasty procedures, respectively. Timely accurate interpretation of postoperative X-rays are crucial in guiding weight-bearing status as well as rehabilitation. Therefore, delays in X-ray acquisition may impact initiation of postoperative rehabilitation and overall length of stay negatively. The aim of this project is to optimise acquisition of postoperative X-rays in patients undergoing implant surgery and as a result increase efficiency of deployed healthcare staff. A multidisciplinary team was formed to study the efficacy of a new workflow for patients to undergo X-rays immediately after surgery while en-route to the ward. Pretrial and in-trial delays in acquiring X-rays and total man-hours spent on transport were recorded. These processes were refined and integrated to optimise the new workflow. Compared with the old workflow, delays in obtaining X-rays were significantly reduced from the longest of 20 hours and 40 min to no delays at all. Overall man-hours spent on transport of these patients were reduced by a mean of 12 and 16 min for nurses and porters, respectively. The trial workflow has since been adopted successfully by our institution and since inception has become standard practice, allowing timely review of postoperative X-rays. This has led to increased workforce efficiency as well as timely rehabilitation and discharge of patients.

An evidence-based nursing care guide for critically ill patients with COVID-19: A scoping Review

Background: Nursing care plays a vital role in critically ill patients’ recovery process and outcome with COVID-19. Though there is a tremendous surge in COVID-19 literature, there is no comprehensive documentation of nursing aspects. Objective: To develop nursing care standards for critically ill patients with COVID-19. Methodology: To prepare this scoping review, a detailed literature review was done by the experts and trainers involved in the critical care of patients with COVID-19 from India’s premier institutes. Results: Rapidly progressing hypoxemia with respiratory failure induced by COVID-19 in critically ill patients poses a management challenge. Patients of COVID-19 progressing to critical stage must be identified early, and appropriate management initiated while taking all the specific measures to prevent infection to the healthcare providers. The essential components of critically ill patients’ nursing care include constant monitoring and maintenance of ventilation, oxygenation, fluid volume/hemodynamic status, and shock prevention. The other adjunctive measures include meeting the nutritional demands, prevention, early identification of complications, timely initiation of rehabilitation, and personal and environmental hygiene. Ensuring the safety of the healthcare providers with adequate PPE and infection control measures is of utmost importance while caring for the patients of COVID-19. Conclusion: The nursing interventions must be tailored vigilantly for the individual patient. The evidence is evolving, and the nursing care strategies discussed in this article based on existing evidence may guide the nurses and healthcare providers in managing critically ill patients of COVID-19.

Effects of assigning physical therapists exclusively to the acute-phase stroke patient ward.

[Purpose] In April 2014, an additional health insurance system aiming to maintain or improve activities of daily living levels was newly established by the Japanese government. The purpose of this study was to determine the influence of this new medical system for rehabilitation on patient management (e.g., activities of daily living level and length of hospital stay) in an acute-phase stroke patient ward. [Participants and Methods] All patients were admitted to the stroke patient ward in our hospital and were registered between January 2012 and December 2019. We assessed the differences in the time to initiation of rehabilitation, length of hospitalization, implementation rate of rehabilitation, and Barthel Index between the period before the start of the new medical system (Prior period) and after this system was started (Post period). [Results] Significant improvements were observed in the initiation of rehabilitation and the difference in the Barthel Index scores after the start of the new medical system. Although the length of hospitalization and implementation rate of rehabilitation did not differ significantly, both indicators gradually improved after the start of the new system. [Conclusion] Our results suggest that the new medical system for rehabilitation is beneficial for patient management in the acute-phase stroke patient ward.

General magnet therapy and low-frequency electrostatic field in the postoperative period in patients with breast cancer

To compare the efficacy of general magnetic therapy and low-frequency electrostatic field on days 2-4 after the radical surgical treatment of breast cancer and 1.0-1.5 months after radiation therapy in combination with therapeutic physical training, motor-cognitive training, and sessions with a psychologist. Examination and medical rehabilitation of 131 patients after radical surgical treatment of breast cancer were performed. Age ranged from 30 to 75 years. Group 1 included 66 patients who received medical rehabilitation on days 2-4 after the surgery and 1.0-1.5 months later in addition to adjuvant radiotherapy; Group 2 included 65 patients who received medical rehabilitation only after 1.0-1.5 months in addition to adjuvant radiotherapy. It was shown that two courses of medical rehabilitation with the addition of physiotherapeutic treatment on days 2-4 and 1.0-1.5 months after radical breast cancer surgery in addition to radiation therapy contribute to a significant reduction of functional disorders severity in patients versus initiation of medical rehabilitation 1.0-1.5 months after the surgery in addition to radiation therapy. The feasibility of including general magnetic therapy procedures and low-frequency electrostatic field exposure in the medical rehabilitation course was demonstrated as it results in pain relief, postoperative edema reduction, and quicker recovery of the shoulder joint mobility that promotes long-term clinical benefit.

Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a clinical diagnosis resulting from the impingement of neurovascular structures between the clavicle and first rib. Effective prevention and nonoperative treatment in high-performance athletes with TOS are not well documented. The objective of reporting this case was to discuss the symptom progression, relevant clinical findings, and rehabilitation of an overhead athlete with diagnosed neurogenic TOS. Numerous rehabilitative techniques may be used to treat an athlete with TOS, with an emphasis on restoring full shoulder mobility, motor control, and normalized scapular mechanics in a throwing athlete, as well as improving functional thoracic range of motion. Modalities such as neuromuscular electrical stimulation and targeted muscle exercises are incorporated in the process. In the case presented, a collegiate-level throwing athlete returned to full participation at her previous level of play within 18 weeks of rehabilitation initiation. This report details the clinical findings and treatment options available to address pathology in an overhead athlete with a diagnosis of TOS. The clinical case example shows techniques that may help guide the clinician in establishing effective nonoperative or postoperative treatments for TOS. Level of EvidenceLevel V, expert opinion.

Impact of rehabilitation and status area change on land cover and carbon storage in Paliyan Wildlife Reserve, Gunung Kidul, Indonesia

Abstract. Puspanti A, Kusumandari A, Faida LRW, Sudaryatno. 2021. Impact of rehabilitation and status area change on land cover and carbon storage in Paliyan Wildlife Reserve, Gunung Kidul, Indonesia. Biodiversitas 22: 3964-3971. This study analyzed the land cover change and carbon storage after the rehabilitation of Paliyan forest. This study mainly focused on the forest status during 1999-2019, especially after establishing a wildlife reserve forest and after rehabilitation activity. We used a combination of canopy density model, carbon conversion, and changes of management-related data to analyze land cover classes in two decades of 1999-2009 and 2009-2019 representing the change in status of the area, rehabilitation, and management dynamics through the time. The result shows that at baseline (1999), the status was still production plantation forest dominated by non-forest/open land with the most carbon storage in plantation forest of 5463.04 tons of carbon. In the first decade, important events occurred such as continuing illegal logging until 2001; change of area status to wildlife reserve forest; and initiation of rehabilitation in 2003. There was an increase in non-forest areas during the first decade, and carbon storage decreased mostly in plantation forests with only 867.71 tons of carbon remaining. In the second decade, rehabilitation has shown a positive impact in increasing forested areas, and altered non-forest to the forested area dominated by open forest/mixed agriculture area, followed by plantation forest, and secondary forest. In this decade, the legality of the area status and rehabilitation activity underwent to be more advance. The carbon storage also shows the positive result with the most increase of storage in plantation forest of 4072.932 tons carbon, or almost 4.7 times higher than that in 2009. Total carbon storage in 2019 was 13257.50 tons, or almost three times higher than that in 2009. The rehabilitation required a longer period to achieve a more dense forest condition as in 2019 the area was still dominated by open forest or agriculture. The smallholder farmers and high dependency of the surrounding community manage the land to feed their livestock, impede the rehabilitation and restoration process, and de-escalate the transition from non-forest to forest resulted in the more vegetated area. This result is important for stakeholders for designing appropriate forest-related policies and supporting further rehabilitation strategies.

Acute-phase initiation of cardiac rehabilitation and clinical outcomes in hospitalized patients for acute heart failure

BackgroundExtensive data support the clinical benefit of cardiac rehabilitation (CR) for patients with chronic heart failure (HF). However, whether CR could be beneficial for patients hospitalized for acute heart failure remains unclear. MethodsWe retrospectively analyzed data from the Diagnosis Procedure Combination database, a nationwide inpatient database. We included patients hospitalized for HF, who were aged ≥20 years and with New York Heart Association class ≥II, between January 2010 and March 2018. We excluded patients with length of hospital stay ≤2 days, those undergoing major procedures under general anesthesia, those requiring advanced mechanical supports within 2 days after admission, and those with disturbance of consciousness. Propensity score matching and instrumental variable analyses were conducted to compare clinical outcomes between the patients with and without acute-phase initiation of CR defined as initiation of CR within two days after hospital admission. ResultsAmong 430,216 eligible patients, 63,470 patients (14.8%) received the acute-phase initiation of CR. Propensity score matching created 63,470 pairs and found that the acute-phase initiation of CR was associated with lower in-hospital mortality (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.73–0.80), shorter hospital stay and lower incidence of 30-day readmission due to HF. The instrumental variable analysis also showed patients with acute-phase initiation of CR was associated with lower in-hospital mortality than those without (OR, 0.73; 95% CI, 0.68–0.79). ConclusionOur analysis suggested a potential benefit of acute-phase initiation of CR for short-term clinical outcomes in hospitalized patients with acute HF.

Comprehensive Rehabilitation After Reconstruction of the Anterior Cruciate Ligament

Introduction: The knee joint is the second most frequently injured joint. Anterior cruciate ligament (ACL) injury is a relatively common injury to the inner part of the knee joint, mainly related to contact sports. Its rupture leads to instability of the entire joint. Two treatment options are possible: operative or conservative. Each of them is related to an appropriate rehabilitation process. The aim of this study was to define a comprehensive rehabilitation plan in patients after ACL rupture and meniscal suturing.Materials and methods: The work was written based on the medical history of the patient who was diagnosed with complete rupture of ACL, and then reconstruction was performed with the harvesting of a semitendinous and slender muscle graft.Results: The rehabilitation process can be divided into two stages: hospital and post-hospital. Rehabilitation in hospital conditions begins on the zero day after arthroscopy. The main goals of rehabilitation include: increasing the range of mobility, no myofascial dysfunctions, no thromboembolic complications, and the ability to self-service.Conclusion: Rehabilitation is an indispensable element of the treatment of patients after ACL reconstruction. Early initiation of rehabilitation brings tangible benefits during treatment and return to full physical fitness.

In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation.

Previous research has demonstrated that early initiation of rehabilitation and direct care pathways improve outcomes for patients with severe traumatic brain injury (TBI). Despite this knowledge, there is a concern that a number of patients are still not included in the direct care pathway. The study aim was to provide an updated overview of discharge to rehabilitation following acute care and identify factors associated with the direct pathway. We analyzed data from the Oslo TBI Registry—Neurosurgery over a five-year period (2015–2019) and included 1724 adults with intracranial injuries. We described the patient population and applied multivariable logistic regression to investigate factors associated with the probability of entering the direct pathway. In total, 289 patients followed the direct pathway. For patients with moderate–severe TBI, the proportion increased from 22% to 35% during the study period. Significant predictors were younger age, low preinjury comorbidities, moderate–severe TBI and disability due to TBI at the time of discharge. In patients aged 18–29 years, 53% followed the direct pathway, in contrast to 10% of patients aged 65–79 years (moderate–severe TBI). This study highlights the need for further emphasis on entering the direct pathway to rehabilitation, particularly for patients aged >64 years.

Brainstem Evoked Auditory Responses in Neonatal Hyperbilirubinemia Infants

Jaundice is a common finding in neonates affecting 70% of term and 80% of preterm neonates during the first week of life. Objective of this study is to evaluate auditory and brainstem responses in hyperbilirubinemia infants and to see if there is any statistically significant increase in latencies of wave I and V waves with rise in bilirubin levels. In the present study we have taken 53 infants with hyperbilirubinemia&gt;11mg% &amp; with no other risk factors like preterm, low birth weight, birth asphyxia and age and sex matched controls who visited pediatric OPD of Bapuji Child Health Centre were evaluated using RMS EMG. EP MARK –II machine. Latencies of Waves I and V and inter-peak latency of I-V were recorded. Latency of wave V and IPL I-V were increased slightly compared to normal control subjects. Increase in the threshold leading to hearing impairment in the affected infants and complete deafness where none of the waves were recorded signify that hyperbilirubinemia is a risk factor for deafness. Since hyperbilirubinemia is a risk factor for hearing impairment, their hearing screening by BERA at the earliest and follow up will help in their earliest initiation of rehabilitation when the brain is sensitive to the development of speech &amp; language.

腸間膜リンパ腫と筋萎縮性側索硬化症（ALS）を併発し，ALS発症早期に敗血症を合併した1例

We treated a patient with mesenteric lymphoma who concomitantly developed amyotrophic lateral sclerosis (ALS). The patient died of urinary tract infection nine months after the onset of ALS. We herein report the changes in the patient's condition and the sequence of events until death from the viewpoint of a physiotherapist. The patient was a 69-year-old woman who developed mesenteric lymphoma in September of X year and perceived weakness in the toes in November of X year. She showed signs of upper and lower motor neuron disorders, and electrophysiologic testing revealed denervation in three areas of the spinal cord. In March of X+1 year, she was diagnosed with definite ALS based on the Awaji criteria. In April of X+1 year, she began to receive continuous home healthcare, specifically outpatient rehabilitation. No remarkable bulbar palsy was observed soon after the initiation of rehabilitation; however, manual muscle testing revealed strengths in the lower and upper limbs of 1 and 3-5, respectively, indicating muscle weakness and muscle atrophy. She developed exacerbation of neurological symptoms in the upper limbs, bulbar palsy, and respiratory muscle paralysis during rehabilitation. The ALS Functional Rating Scale-Revised indicated a decreased tendency to X [please define X]. In July of X+1 year, the mesenteric lymphoma had enlarged, resulting in the development of ureteric obstruction and ultimately causing hydronephrosis. Urinary tract infection and sepsis were diagnosed, and she was hospitalized. Although her fever temporarily subsided following ceftriaxone administration, she ultimately died due to a systemic inflammatory response syndrome three days after hospitalization. The mean period between the ALS onset and death is reportedly 40.6±33.1 months. The rate of ALS progression differs among individuals. Malignant tumors and paraneoplastic neurological syndrome may be involved in rapidly worsening neurological symptoms. Patients who concomitantly develop motor neuron disorders and malignant tumors are likely to have a higher risk of developing serious conditions associated with the exacerbation of neurological symptoms and complications. Our patient had several diseases that affected her survival prognosis; however, the sharing of information regarding her condition among healthcare professionals may have been insufficient. The primary physician responsible for treating each disease should cooperate with physiotherapists and other paramedical staff who have frequent opportunities to talk to patients in daily clinical practice. In geriatric patients in particular, such an environment is essential.

Association between Initiation of Pulmonary Rehabilitation and Rehospitalizations in Patients Hospitalized with Chronic Obstructive Pulmonary Disease.

Rationale: Although clinical trials have found that pulmonary rehabilitation (PR) can reduce the risk of readmissions after hospitalization for a chronic obstructive pulmonary disease (COPD) exacerbation, less is known about PR’s impact in routine clinical practice. Objectives: To evaluate the association between initiation of PR within 90 days of discharge and rehospitalization(s). Methods: We analyzed a retrospective cohort of Medicare beneficiaries (66 years of age or older) hospitalized for COPD in 2014 who survived at least 30 days after discharge. Measurements and Main Results: We used propensity score matching and estimated the risk of recurrent all-cause rehospitalizations at 1 year using a multistate model to account for the competing risk of death. Of 197,376 total patients hospitalized in 4,446 hospitals, 2,721 patients (1.5%) initiated PR within 90 days of discharge. Overall, 1,534 (56.4%) patients who initiated PR and 125,720 (64.6%) who did not were rehospitalized one or more times within 1 year of discharge. In the propensity-score–matched analysis, PR initiation was associated with a lower risk of readmission in the year after PR initiation (hazard ratio, 0.83; 95% confidence interval, 0.77–0.90). The mean cumulative number of rehospitalizations at 1 year was 0.95 for those who initiated PR within 90 days and 1.15 for those who did not (P < 0.001). Conclusions: After hospitalization for COPD, Medicare beneficiaries who initiated PR within 90 days of discharge experienced fewer rehospitalizations over 1 year. These results support findings from randomized controlled clinical trials and highlight the need to identify effective strategies to increase PR participation.

ПИТАННЯ ЗАКРИТТЯ КРИМІНАЛЬНОГО ПРОВАДЖЕННЯ ЩОДО ПОМЕРЛОГО ОБВИНУВАЧЕНОГО У СУДОВОМУ ПРОВАДЖЕННІ

Based on the analysis of judicial practice, the paper examines the problem of criminal proceedings’ closing in case of suspect’s or accused’s death, except in cases where the proceedings are necessary for the rehabilitation of the deceased, in preparatory proceedings, trials, appeals and cassation proceedings. The purpose of the paper is to identify the characteristics of interpretation and application of paragraph 5 of Part 1 of Art. 284 of the CPC of Ukraine in the proceedings of the court of the first instance, appeal and cassation proceedings, to formulate proposals for amendments to the CPC of Ukraine on the closure of the proceedings on this ground. The main results of the research consist of substantiating the need to standardize the appropriate legal procedure for the rehabilitation of the deceased by enshrining it in the CPC of Ukraine; determination of procedural decisions of the court in the preparatory proceedings and the trial in case of person’s death; determination of procedural decisions of the court in appeal proceedings in case of death of a person in respect of whom an acquittal has been passed; determination of procedural court decisions in appeal proceedings in the event of the death of the acquitted. The conclusions and specific proposals of the author are as follows: the application of paragraph 5 of Part 1 of Art. 284 of the CPC of Ukraine is not well-established in judicial practice, which indicates the lack of uniform interpretation of Art. 284, 417, 440 of the CPC of Ukraine, and the need to clarify the provisions of Art. 417, 440 of the CPC of Ukraine. Guided by paragraph 5 of Part 1 of Art. 284 of the CPC of Ukraine in the preparatory proceedings, the court by its decision closes the criminal proceedings unless the proceedings are necessary for the rehabilitation of the deceased; in court proceedings, the court closes the criminal proceedings by its decision, except in cases when the proceedings are necessary for the rehabilitation of the deceased, in case of initiation of rehabilitation, which has not been confirmed - by its decision closes the criminal proceedings. The wording of Art. 417 and 440 of the CPC of Ukraine do not take into account the difference in the grounds for closing the criminal proceedings and are not adapted for such grounds as the death of the accused. Therefore, it is appropriate to remove from these articles the reference to the reversal of the conviction only. However, as in the case of acquittal, the person is rehabilitated, in case of objections of the defence to revoke the acquittal, it cannot be revoked, however, the proceedings should be closed and further review of court decisions is impossible.

Potential association between initiation of pulmonary rehabilitation within 90 days following hospitalization for COPD and improved 1-year all-cause mortality.

Dwight D. Eisenhower Army MC FMR, Fort Gordon, GA The authors declare no conflicts of interest. The opinions and assertions contained herein are those of the authors and are not to be construed as official or as reflecting the views of the US Army Medical Department, the Army at large, or the Department of Defense.