Rehabilitation Hospital Research Articles

Hydralazine Induced Vasculitis: A Case Report

Background:: Hydralazine has been used in the treatment of hypertension and heart failure for a long time. It has been associated with the development of Vasculitis and Drug induced lupus. This is a male patient in his sixties who was admitted at the hospital and prescribed hydralazine. He developed Hydralazine-induced lupus with Pancytopenia and renal failure. This case report has been written to raise awareness about the hydralazine side effects. Case Presentation:: This case report describes a 68-year-old male, transferred to our hospital for rehabilitation. He was tracheostomized. He is hypertensive with a history of CVA. BP was elevated during the admission. He has no family history of immunological diseases or any allergies. 6 months after hydralazine, the patient started to have a purpuric rash over the lower limbs and an elevated renal profile. Only Direct Coomb’s test was positive. He had hematuria and pancytopenia also. He was started on steroids and he became edematous. On March 2021, the hydralazine was stopped and the patient's blood tests improved, the rash disappeared and hematuria stopped. Unfortunately, he got fungemia and septicemia with pneumonia. He became hypotensive and anuric. The patient kept deteriorating and passed away. Discussion:: Hydralazine is not a first line choice for the treatment of hypertension. Common side effects include tachycardia and headache. It can also cause drug-induced lupus. Conclusion:: Hydralazine has been used in the treatment of hypertension and heart failure for a long time. It has been associated with the development of Vasculitis and Drug induced lupus.

Status of Vision and Eye Care Among Patients in Rehabilitation Hospital Units: A Cross-Sectional Study

ObjectivesThe prevalence of vision disorders is high among geriatric and hospital inpatient populations, yet they often go undetected, resulting in consequences such as falls or prolonged recovery time. A needs assessment study was conducted to investigate levels of vision and the potential prevalence of unmanaged/undiagnosed ocular disorders among adult inpatients in a hospital-based rehabilitation unit. DesignCross-sectional study. Setting & ParticipantsInpatient rehabilitation units of an acute care hospital system in Ontario, Canada. Adults (n = 112) in a hospital inpatient rehabilitation unit participated from October 2018 to February 2019. MethodsParticipants were surveyed regarding their demographic, ocular, and medical data and spectacle wear. Visual acuity, contrast sensitivity, visual fields, and stereoacuity plus the spectacle condition were directly assessed. ResultsThe majority (75%) were found to have reduced habitual vision while in hospital. Nearly 60% of participants reported at least some difficulty reading a newspaper or distinguishing a face or were “not happy with their vision.” This was despite 80% of participants reporting that they had an eye care practitioner and 70% that they had an eye examination within the last 2 years. More than half (51.8%) of the participants received the recommendation to follow up with their eye care practitioner on discharge from the hospital. Conclusions and ImplicationsReduced vision and vision disorders has a high prevalence among hospital patients in rehabilitation units and should be evaluated at or soon after hospital intake. By incorporating vision screening tools, necessary precautions may be taken to avoid possible falls and promote recovery.

Ripple effects of small group care for patients with dementia in hospital on ward nurses

AbstractBackgroundThe average length of stay in general beds is about 16 days in Japan . Providing quality care to inpatients with dementia has been a challenge in acute hospitals. In Japan, “in‐hospital daycare”, in which patients gather in specific places in the hospital for recreation and rehabilitation, is increasing. Therefore, we aimed to clarify the current situation of “in‐hospital daycare” at hospitals in Japan and the ripple effect on dementia care in wards.MethodA web‐based survey was conducted on 1,101 nurses working in hospitals who are certified as experts of dementia or geriatric care.ResultData were obtained from 272 nurses (response rate: 24.7%). 38 nurses (14%) have provided “in‐hospital daycare”, and 51 nurses (18.8%) provided it before the COVID‐19 pandemic. We analyzed data of these 89 nurses.91.0% of them recognized that “in‐hospital daycare” was effective for the patients who participated. In addition, they reported the ripple effect on ward nurses. Ripple effects are 〈ward nurses are more supportive of patient activity/diversional activity 〉〈Ward nurses are more aware of patient strengths〉〈Ward nurses noticed new aspects of patients and backgrounds, and deepened their understanding of patients〉〈Increased conversations between ward nurses and patients〉and so on.ConclusionAlthough only about 30% of facilities provide “in‐hospital day care”, it has not only an effect on participating patients, but also has a ripple effect on ward nurses. Results suggest that it contributes to improving the quality of dementia care in the ward.

Stroke severity to determine musculoskeletal symptoms in family caregivers.

the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients' physical health and disability level. a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients' Functional Ambulation Score(FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients' functional capacity and disability levels. NCT04901637 (1) Stroke survivors highly depend on informal caregivers for daily living. (2) Family caregivers are at an increased risk of experiencing musculoskeletal problems. (3) The caregivers' musculoskeletal symptoms are related to the level of the patient disability. (4) Preventive medicine should become a part of nursing education for family caregivers.

Gravidade do AVC e determinação dos sintomas musculoesqueléticos dos cuidadores familiares

Objective: the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. Method: the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients’ physical health and disability level. Results: a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients’ Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. Conclusion: according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients’ functional capacity and disability levels. Clinical trials number: NCT04901637

Coronary Heart Disease, Cognitive Impairment and Patient‐Physician‐Communication: Data from the MenDis‐CHD study

AbstractBackgroundCoronary heart disease (CHD) and dementia often co‐occur in the aging population. In addition, CHD seems to increase the risk for subsequent cognitive decline, which may in turn negatively affect the prognosis of CHD. Current CHD guidelines therefore recommend appropriate diagnosis and management of comorbid cognitive impairment. Here, we present the progression and characteristics of cognitive impairment in a group of patients with CHD and their perception of care in the patient‐physician‐relationship.MethodFor the MenDis‐CHD study, n = 364 patients with CHD were recruited from cardiologic hospital departments, rehabilitation clinics and cardiologist practices in Cologne, Germany. Medical records were used to assess severity of CHD and comorbidities. The New York Heart Association (NYHA) Functional Classification was applied for estimation of heart failure‐related symptom severity. Each patient was screened for cognitive impairment (DemTect) and depressive or anxiety symptoms (HADS questionnaire) as well as for subjective cognitive deficits. Patients were asked whether cognitive impairment was discussed with the treating physician. A follow‐up was carried out after M = 3.19 [2.2‐4.2] years in n = 118 patients. We compared patients whose cognition declined based on DemTect score to those who remained stable using t‐tests/Mann‐Whitney‐U‐tests and X²‐tests.ResultAt baseline, 10.2% of patients were screened positive for cognitive impairment, while 18.4% reported subjective cognitive deficits. Patients with a decline in cognition between study visits were significantly older (M = 67.9 vs. M = 63.1, t(115) = ‐2.7, p = .009) and showed more depressive symptoms (M = 5.0 vs. M = 3.8, t(115) = ‐2.1, p = .039). They also had more severe NYHA grades (M = 2.1 vs. M = 1.7, U(102) = 2044.5, p = .011) and a concomitant cerebrovascular diagnosis was more frequent compared to patients who did not decline (20.0% vs. 4.1%, X²(1) = 5.2, p = .048). Out of those who experienced either subjective or objective impairment at baseline (n = 88), 38.6% indicated that cognitive symptoms had previously been addressed during visits with their primary attending physician and 9.1% had been actively approached by their physician in this regard.ConclusionA relevant proportion of CHD patients displayed cognitive symptoms at baseline with progression at follow‐up. Conversations about cognitive symptoms with the physician occurred only in a minority. Our data supports the importance of raising awareness about the link between CHD and cognitive impairment in physicians.

The mediation effect of social support between stigma and social alienation in patients with stroke.

Social alienation is prevalent and causes adverse outcomes in stroke. Previous studies have linked stigma with social alienation. However, little is known about the mechanisms behind this relationship. This study explored the mediation effects of social support between stigma and social alienation. A cross-sectional design was used to study 248 patients with stroke admitted to a tertiary rehabilitation hospital in Beijing, China, from December 2022 to July 2023. Patients were assessed using a general information questionnaire, the Stroke Stigma Scale, the Social Support Rating Scale, and the Generalized Social Alienation Scale. The PROCESS macro in SPSS was used to examine the mediation model. The results showed that stigma has a negative effect on social support (β = -0.503, p<0.001); stigma has a positive effect on social alienation (β = 0.768, p<0.001). Social support mediated the relationship between stigma and social alienation, with a mediation effect of 0.131 (95%CI: 0.060, 0.214), and indirect effects accounted for 17.06% of the total effect. Social support mediated the relationship between stigma and social alienation. These findings suggest that intervention targeting the enhancement of social support may prevent or reduce social alienation among patients with stroke.

Machine Learning Web Application for Predicting Functional Outcomes in Patients With Traumatic Spinal Cord Injury Following Inpatient Rehabilitation.

Accurately predicting functional outcomes in patients with spinal cord injury (SCI) helps clinicians set realistic functional recovery goals and improve the home environment after discharge. The present study aimed to develop and validate machine learning (ML) models to predict functional outcomes in patients with SCI and deploy the models within a web application. The study included data from the Japan Association of Rehabilitation Database from January 1, 1991, to December 31, 2015. Patients with SCI who were admitted to an SCI center or transferred to a participating post-acute rehabilitation hospital after receiving acute treatment were enrolled in this database. The primary outcome was functional ambulation at discharge from the rehabilitation hospital. The secondary outcome was the total motor Functional Independence Measure (FIM) score at discharge. We used binary classification models to predict whether functional ambulation was achieved, as well as regression models to predict total motor FIM scores at discharge. In the training dataset (70% random sample) using demographic characteristics and neurological and functional status as predictors, we built prediction performance matrices of multiple ML models and selected the best one for each outcome. We validated each model's predictive performance in the test dataset (the remaining 30%). Among the 4181 patients, 3827 were included in the prediction model for the total motor FIM score. The mean (standard deviation [SD]) age was 50.4 (18.7) years, and 3211 (83.9%) patients were male. There were 3122 patients included in the prediction model for functional ambulation. The CatBoost Classifier and regressor models showed the best performances in the training dataset. On the test dataset, the CatBoost Classifier had an area under the receiver operating characteristic curve of 0.8572 and an accuracy of 0.7769 for predicting functional ambulation. Likewise, the CatBoost Regressor performed well, with an R2 of 0.7859, a mean absolute error of 9.2957, and a root mean square error of 13.4846 for predicting the total motor FIM score. The final models were deployed in a web application to provide functional predictions. The application can be found at http://3.138.174.54:8501. In conclusion, our prediction models developed using ML successfully predicted functional outcomes in patients with SCI and were deployed in an open-access web application.

Rehabilitation of Adult Patients with Pulmonological Manifestations of Long COVID: a Review

INTRODUCTION. The most common symptoms in patients who have had a new coronavirus infection (COVID-19) are associated with pulmonary lesions (shortness of breath, chest pain, cough) and the same complaints persist in the majority of those suffering from long COVID the occurrence and prevalence of which in the population is inextricably linked with the number recovered from COVID-19.&#x0D; AIM. To study the current state of the problem of diagnosis, treatment and rehabilitation of patients with pulmonological manifestations of long COVID at the stage of a specialized rehabilitation hospital in order to formulate basic practical recommendations for the management of this category of patients.&#x0D; MATERIALS AND METHODS. During the period from January 1, 2021 to December 1, 2022, we performed a systematic search of the MEDLINE, Cyberleninka, and eLIBRARY.RU databases on the topic of pulmonary manifestations of long COVID and methods of their rehabilitation in adult patients that gave 678 matches. After further filtering steps according to the methodology outlined in the PRIZMA guidelines, we selected 60 publications for the final analysis.&#x0D; RESULTS. Pulmonary manifestations of long COVID, including, first of all, shortness of breath, rank second after fatigue in terms of frequency of occurrence in long COVID. Diagnostic findings include radiologic pulmonary tissue changes recorded in a proportion of patients under one year, restrictive abnormalities on spirometry, and impaired pulmonary diffusion capacity. Many patients who have had COVID-19 recover quite quickly, but some of them have a long-term symptom complex of dyspnea and physical fatigue, for which rehabilitation in a specialized centers is indicated.&#x0D; The most effective treatment is possible with the involvement of a multidisciplinary rehabilitation team in the rehabilitation process and the appointment of rehabilitation programs created in accordance with the conceptual basis of respiratory rehabilitation, including, first of all, a wide range of methods of therapeutic physical culture.&#x0D; The most effective treatment is possible by involving a multidisciplinary rehabilitation team in the rehabilitation process and prescribing rehabilitation programs designed in accordance with the conceptual framework of respiratory rehabilitation, including, above all, a wide range of therapeutic physical education techniques.&#x0D; CONCLUSION. Current knowledge of the clinical picture, diagnosis, treatment and rehabilitation measures in long COVID is constantly reassessed and expanded. This literature review gives an analysis of research papers focused on the treatment and rehabilitation of pulmonary manifestations in adults, combining the etiopathogenetic and syndromic approaches characteristic of the “classical Russian therapeutic” and, closest to it, the “German” schools. The information extracted both from documents published by World Health Organization (WHO) and from local Russian and European clinical guidelines will allow a specialist engaged in the rehabilitation of adults with pulmonary manifestations of long COVID to create an effective and personalized individual rehabilitation plan for each patient.

Unit cost per inpatient day of rehabilitative care services at 272 bedded Rheumatology and Rehabilitation Hospital in Sri Lanka

Unit cost per inpatient day of rehabilitative care services at 272 bedded Rheumatology and Rehabilitation Hospital in Sri Lanka

The prototype of a frailty learning health system: The HARMONY Model.

Rapid translation of research findings into clinical practice through innovation is critical to improve health systems and patient outcomes. Access to efficient systems of learning underpinned with real-time data are the future of healthcare. This type of health system will decrease unwarranted clinical variation, accelerate rapid evidence translation, and improve overall healthcare quality. This paper aims to describe The HARMONY model (acHieving dAta-dRiven quality iMprovement to enhance frailty Outcomes using a learNing health sYstem), a new frailty learning health system model of implementation science and practice improvement. The HARMONY model provides a prototype for clinical quality registry infrastructure and partnership within health care. The HARMONY model was applied to the Western Sydney Clinical Frailty Registry as the prototype exemplar. The model networks longitudinal frailty data into an accessible and useable format for learning. Creating local capability that networks current data infrastructures to translate and improve quality of care in real-time. This prototype provides a model of registry data feedback and quality improvement processes in an inpatient aged care and rehabilitation hospital setting to help reduce clinical variation, enhance research translation capacity, and improve care quality.

Parkinson's disease physical therapy services during COVID-19: A phenomenological study.

Parkinson's disease (PD) is the most rapidly increasing movement disorder globally. Physical therapies improve the motor and non-motor symptoms of PD. During the COVID-19 pandemic, telehealth was the primary method of physical therapy service adaptation in response to restrictions preventing in-person therapy attendance. This study explores the perspectives of people with PD and their therapists who experienced physical therapy service delivery before and during the COVID-19 pandemic in Melbourne, Australia. A phenomenological study that purposively recruited patients and therapists from a movement disorders service at an outer metropolitan rehabilitation hospital. Participants completed in-depth interviews, and data were analysed using reflexive thematic analysis. Ten people with PD and five therapists completed interviews. Six themes were identified: patients value access to therapy, a key mechanism is trust, an opportunity to empower patients, ticking boxes for telehealth, contrasting experiences of telehealth and something is better than nothing. This study explored the experiences of people with PD and their therapists by contrasting their prepandemic and in-pandemic experiences. People with PD valued telehealth access during the pandemic, but extra support was initially required to use telehealth successfully. Empowering aspects of telehealth included patients learning new skills and self-management strategies from telehealth interactions with therapists. Therapists at this health service were motivated to continue with telehealth beyond the pandemic. Despite finding it challenging initially, they were surprised by how well people with PD managed telehealth using locally developed procedures based on clinical judgement and staff training that addressed patient safety while supporting people with PD to utilise telehealth.

Understanding the experience of users of communication aids and applications through focus group discussions with people with aphasia and family members

The present study sought to identify the communication needs of persons with aphasia (PWA) and of their spouses, that could ultimately be addressed with current communication aids or applications (CA/A). Among users of CA/A we solicited their opinions and experiences with current CA/A. In contrast, among those not using CA/A, we explored why they did not use CA/A. A qualitative experiential research design was used through two in-person focus groups, one in English and one in French, at a large rehabilitation hospital in the Greater Montréal region (Canada). Participants' responses were recorded, transcribed and analyzed. The thematic analysis that ensued allowed the identification of four main themes. The first theme reflects participants' observations and experiences when communicating with aphasia. The second theme regrouped responses related to successful communication with the help of CA/A. The participants' challenges and dissatisfaction with CA/A were grouped into the third theme. Lastly, a fourth theme included participants' general views about CA/A and their wishes for further development. Participants' experience with communication difficulties following aphasia and the barriers and potential facilitators to adoption of CA/A were brought to the forefront. They also highlighted those features necessary to ensuring functional uptake of CA/A by those who would benefit from it. Finally, the importance of providing training to the communication partner and sensitizing the public to the impact of aphasia on people's daily lives and on the potential benefits of using CA/A were raised as necessary future actions.

Prosthetic Curricular Threads: Pilot Survey of Clinical Practice and Physical Therapy Education

ABSTRACT Introduction Physical therapists play a critical role in the rehabilitation of persons with limb loss/limb difference. The introduction to the skills and knowledge necessary to provide skilled care occurs during the physical therapist’s education in an accredited physical therapy program. Although clinical practice evolves as technological changes manifest and the evidence base progresses, it is unclear whether physical therapy education is adapting to stay current with clinical practice. Purpose The aim of this study was to explore the alignment of clinical practice with physical therapy education as it relates to prosthetic-specific curriculum. Methods Surveys were sent to inpatient rehabilitation hospitals, prosthetic service clinics, and accredited physical therapy programs. Each survey was designed to assess both limb loss/limb difference rehabilitation and prosthetic specific-content germane to the setting being surveyed. Results Sixty-eight physical therapy programs, 48 prosthetic-service providers, and 14 rehabilitation hospitals responded. Just over one third of physical therapy education programs reported having a course dedicated solely to prosthetic-related content. There was general alignment between what is being taught and what is being practiced in the clinics; however, there was variation in specific content and time devoted to prosthetic-related curriculum across programs. Conclusions Further alignment of prosthetic-related content and clinical practice is needed in physical therapy programs. Clinical Relevance Statement More careful alignment of prosthetic curricular content with clinical practice in physical therapy programs will increase the effectiveness of rehabilitation programs and help persons with amputations regain more function and quality of life.

Conceptual Development on Factors influencing Customers Satisfaction in Private Rehabilitation Hospitals in Klang Valley

Rehabilitation medicine is a specialized interdisciplinary medicine that requires the cooperation and involvement of multiple healthcare teams working together towards the recovery and improvement of the quality of the involved patients. The increasing incidence of acute diseases such as stroke and the ageing population brings an increasing need for rehabilitation in Malaysia. However, there are limited academic studies conducted on customer satisfaction in private rehabilitation services, especially in Malaysia. Thus, this conceptual paper is visualized to demonstrate the antecedents of customer satisfaction in private rehabilitation hospitals from a Malaysian perspective, particularly in Klang Valley. A total of fifteen studies with regard to patient and family satisfaction in various healthcare services were reviewed and analysed. In order to determine the independent variables for conceptual framework development, a frequency analysis was done. The finding specified that information communication, treatment service quality, healthcare delivery process, infrastructure and facilities and physician factors are significantly influencing customer satisfaction in healthcare services. Based on the conceptual framework, an empirical study is planned in the future to investigate the factors influencing customer satisfaction in private rehabilitation hospitals. All five independent variables are found to correspond with the five dimensions of the SERVQUAL model.

Inclusivity in Occupational Participation: Life Stories of Bangladeshi With Spinal Cord Injury.

This research aimed to describe the process of occupational participation among persons with spinal cord injury (SCI) discharged from the only SCI rehabilitation hospital in Bangladesh. We analyzed seven participants' interview transcripts and observations using the trajectory equifinality model. Study participants demonstrated the following occupational participation trajectories: (a) employing a strategy or difficulty in occupational participation; (b) performing solidarity or experiencing deprivation; (c) creating identity or divergence; and (d) being included in or excluded from everyday life. There are four pathways: (I) discouraging conditions that minimized daily performance; (II) reinforcing obligatory connections to optimization of daily performance; (III) reciprocity to facilitate social activities; and (IV) manipulating mastery in occupational participation. Occupational therapists can consider the trajectory phases and pathways of occupational participation when facilitating the inclusion of service users after discharge from the hospital.

Gait training using a wearable robotic hip device for incomplete spinal cord injury: A preliminary study

Context/Objective To explore changes in gait functions for patients with chronic spinal cord injury (SCI) before and after standard rehabilitation and rehabilitation with a wearable hip device, explore the utility of robot-assisted gait training (RAGT), and evaluate the safety and dose of RAGT. Design Single-arm, open-label, observational study. Setting A rehabilitation hospital. Participants Twelve patients with SCI. Interventions Standard rehabilitation after admission in the first phase. RAGT for two weeks in the second phase. Outcome measures Self-selected walking speed (SWS), step length, cadence, and the 6-minute walking distance were the primary outcomes. Walking Index for SCI score, lower extremity motor score, and spasticity were measured. Walking abilities were compared between the two periods using a generalized linear mixed model (GLMM). Correlations between assessments and changes in walking abilities during each period were analyzed. Results After standard rehabilitation for 66.1 ± 36.9 days, a period of 17.6 ± 3.3 days of RAGT was safely performed. SWS increased during both periods. GLMM showed that the increase in cadence was influenced by standard rehabilitation, whereas the limited step length increase was influenced by RAGT. During RAGT, the increase in step length was related to an increase in hip flexor function. Conclusions Gait speed in patients with SCI increased after rehabilitation, including RAGT, in the short-term. This increase was associated with improved muscle function in hip flexion at the start of RAGT. Trial Registration: This study was registered with the UMIN Clinical Trials Registry (UMIN-CTR; UMIN000042025)

Prevalence of Multidrug-Resistant and ESBL-Producing Bacterial Pathogens in Patients with Chronic Wound Infections and Spinal Cord Injury Admitted to a Tertiary Care Rehabilitation Hospital.

A pressure ulcer is defined as a skin lesion of ischemic origin, a condition that contributes to morbidity and mortality in patients with spinal cord injuries. The most common complication of ulcers is a bacterial infection. Antimicrobial therapy should be selected with caution for spinal cord injury patients since they have a high risk of developing multidrug-resistant (MDR) infections. The aim of this study was to determine the prevalence of different bacterial pathogens in patients with pressure ulcers admitted with spinal cord injuries. This was a retrospective single-center study that included adult patients aged 18 years and above, admitted with chronic pressure wounds after a spinal cord injury requiring hospitalization between 2015 and 2021. A total of 203 spinal cord injury patients with pressure ulcers were included in the study. Ulcers were commonly infected by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli, and they were mostly located in the sacral and gluteal areas. More than half of the bacteria isolated from patients were sensitive to commonly tested antibiotics, while 10% were either MDR- or pan-drug-resistant organisms. Of the MDR bacterial isolates, 25.61% were methicillin-resistant S. aureus, and 17.73% were extended-spectrum beta-lactamase Enterobacteriaceae. The most prevalent bacteria in pressure ulcers of spinal cord injury patients were S. aureus. Other antibiotic-resistant organisms were also isolated from the wounds.

Synergistic effect of Tai Chi and transcranial direct current stimulation on memory function in patients with mild cognitive impairment: study protocol for a 2×2 factorial randomised controlled trial

IntroductionInterventions at the mild cognitive impairment (MCI) stage prevent or delay the progression of cognitive decline. In recent years, several studies have shown that physical exercise combined with transcranial direct...

Drug abuse rehabilitation policies in Indonesia: a comparison with Vietnam, Australia and Portugal

This article wants to analyze the judge's verdict orientation of the rehabilitation case for addicts or drug abusers. Far from the construction of rehabilitation laws in Indonesia, there is a diffusion of norms between the health and the criminal approach. Legal research with a constitutional and case approach at the state court in Bali and Yogyakarta. A comparative approach of law with other countries. The study suggests that judges are more likely to drop sentences in prison sentences than in rehabilitation, even though the accused meets the criteria of narcotics law and a writ of avoidance of the Supreme Court. The complaint was merely a recommendation that judges were not required to comply with, as was the case in Portugal and Australia. The judge's paradigm of self-initiated drug abuse, like narcotics crimes, is similar in Vietnam. Whereas the philosophical orientation of the judges in deciding the issue of rehabilitation should be based on principles of humanity and justice as governed by the just and civilized precepts of humanity and the precepts of social justice for all peoples of Indonesia. The judge is required to consider the report on the results of the conviction of both criminal and criminal action to the perpetrator of criminal narcotics. Also, future prescriptions for self-initiated drug abuse recovery should be changed with a health approach, drawing a firm line of distinguishing from narcotics crimes. Process in court with a fast trial, including an arrangement for arrest, was held in a designated rehabilitation facility or hospital.