Search results for: rehabilitation inpatient

Authors: Murad Gasanov, Shagen Danielyan, Ali Gasanov, Yuri Teterin, Peter Yartsev

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Background: Despite the advances made in modern surgery, the treatment of patients with esophageal injuries remains one of the most topical and complex issues. In recent years, high-technology minimally invasive methods, such as endoscopic vacuum therapy (EVT) in the treatment of esophageal injuries. The effectiveness of EVT has been sufficiently studied in case of failure of esophageal anastomoses, however the application of this method in case of mechanical esophageal injuries is limited by a small series of observations, indicating the necessity of additional study. Aim: The aim was to аnalyzed of own experience in the use of endoscopic vacuum therapy (EVT) in a comprehensive examination of patients with esophageal injuries. Methods: We analyzed the results of treatment of 24 patients with mechanical injuries of the esophagus for the period 2019-2021. Complex treatment of patients included the use of minimally invasive technologies, including percutaneous endoscopic gastrostomy (PEG), EVT and video-assisted thoracoscopic debridement. Evaluation of the effectiveness of treatment was carried out using multislice computed tomography (MSCT), endoscopy and laboratory tests. The duration of inpatient treatment and the duration of EVT, the number of system replacements, complications and mortality were taken into account. Result: EVT in patients with mechanical injuries of the esophagus allowed to achieve epithelialization of the esophageal defect in 21 patients (87.5%) in the form of linear scar on the site of perforation or pseudodiverticulum. Complications were noted in 4 patients (16.6%), including bleeding (2) and and esophageal stenosis in the perforation area (2). Lethal outcome was in one observation (4.2%). Conclusion. EVT may be the method of choice in complex treatment in patients with esophageal lesions.

Keywords: esophagus injuries, damage to the esophagus, perforation of the esophagus, spontaneous perforation of the esophagus, mediastinitis, endoscopic vacuum therapy

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Authors: Gordon Weight, Hermione Tsoi, Patrick Cutinha, Sanjay Rajpal

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Aim: Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction and lower urinary tract symptoms (LUTS). In this retrospective study, we aim to explore the patient selection, perioperative morbidity, and functional outcomes of GLLP. Methods: Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems. Results: 305 patients were included in this study with a mean age of 73 (range 30-90) years. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term catheters (LTC) or intermittent catheterisation (ISC), followed by failed medical therapy for LUTS (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy. Inpatient stays were minimal, with the majority (68.2%) of patients were performed as day case, and only 10.5% of patients requiring more than a single night admission. The 3-month readmission rate was 10.8%, with the most common causes being haematuria and urinary-tract infection. The successful TWOC rate at follow up was 91.2%. Amongst the 19 patients who failed TWOC, 14 had LTC prior to the procedure and 4 had been performing ISC. Conclusions: Our study shows that GLLP is a safe and effective day case treatment and can be suitable for elderly and comorbid patients. Patients requiring LTC or ISC pre-operatively should be counselled carefully about the risk of not being catheter-free post procedure.

Keywords: urology, endourology, prostate, bladder outlet obstruction, laser

Procedia PDF Downloads 62

Authors: Monique M. Keller, Roline Barnes, Corlia Brandt

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Introduction Scientific evidence on the hand forces and the types of grasps measurement during daily tasks are lacking, leaving a gap in the field of hand rehabilitation and robotics. Measuring the grasp forces and types produced by the individual fingers during daily functional tasks is valuable to inform and grade rehabilitation practices for second to fifth metacarpal fractures with robust scientific evidence. Feix et al, 2016 identified the most extensive and complete grasp study that resulted in the GRASP taxonomy. Covid-19 virus changed data collection across the globe and safety precautions in research are essential to ensure the health of participants and researchers. Methodology A cross-sectional study investigated six healthy adults aged 20 to 59 years, pilot participants’ hand forces during 105 tasks. The tasks were categorized into five sections namely, personal care, transport and moving around, home environment and inside, gardening and outside, and office. The predominant grasp of each task was identified guided by the GRASP Taxonomy. Grasp forces were measured with 13mm force-sensing resistors glued onto a glove attached to each of the dominant and non-dominant hand’s individual fingers. Testing equipment included Flexiforce 13millimetres FSR .5" circle, calibrated prior to testing, 10k 1/4w resistors, Arduino pro mini 5.0v – compatible, Esp-01-kit, Arduino uno r3 – compatible board, USB ab cable - 1m, Ftdi ft232 mini USB to serial, Sil 40 inline connectors, ribbon cable combo male header pins, female to female, male to female, two gloves, glue to attach the FSR to glove, Arduino software programme downloaded on a laptop. Grip strength measurements with Jamar dynamometer prior to testing and after every 25 daily tasks were taken to will avoid fatigue and ensure reliability in testing. Covid-19 precautions included wearing face masks at all times, screening questionnaires, temperatures taken, wearing surgical gloves before putting on the testing gloves 1.5 metres long wires attaching the FSR to the Arduino to maintain social distance. Findings Predominant grasps observed during 105 tasks included, adducted thumb (17), lateral tripod (10), prismatic three fingers (12), small diameter (9), prismatic two fingers (9), medium wrap (7), fixed hook (5), sphere four fingers (4), palmar (4), parallel extension (4), index finger extension (3), distal (3), power sphere (2), tripod (2), quadpod (2), prismatic four fingers (2), lateral (2), large-diameter (2), ventral (2), precision sphere (1), palmar pinch (1), light tool (1), inferior pincher (1), and writing tripod (1). Range of forces applied per category, personal care (1-25N), transport and moving around (1-9 N), home environment and inside (1-41N), gardening and outside (1-26.5N), and office (1-20N). Conclusion Scientifically measurements of finger forces with careful consideration to types of grasps used in daily tasks should guide rehabilitation practices and robotic design to ensure a return to the full participation of the individual into the community.

Keywords: activities of daily living (ADL), Covid-19, force-sensing resistors, grasps, hand forces

Procedia PDF Downloads 186

Authors: Shedy Maharani Nariswari, Prima Agustia Nova, I. Made Kariasa

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Background. Heart Failure (HF) is a chronic and progressive condition associated with significant morbidity, mortality, health care expenditures, and a high readmission rate over the years. Self‐care is essential to manage chronic heart failure in the long term, and it is related to better outcomes and can enhance the quality of life. Objective. The aims of this study were to describe the relationship between self-care behavior and quality of life among heart failure patients in East Jakarta, Indonesia. Methods. This study used a correlational-descriptive design with a cross-sectional study, the sampling method used purposive sampling method. Self-care was measured using Self-care Heart Failure Index version 6.2, and quality of life was measured using The Minnesota Living with Heart Failure. Pearson correlation and Spearman-rho correlations are used to analyze the data. Results. We recruited 103 patients with HF in both outpatient and inpatient ward: mean age 59.26 ± 11.643 years, 63.1% male. Patients with higher levels of education were associated with higher self-care maintenance (p= 0.007). The patient's average quality of life is quite high, with a score of 72,07 ± 16,89. There were a significant relationship among self-care maintenance (r=0,305, p=0,001), self-care management (r=0,330, p=0,001), and self-care confidence (r=0,335, p=0,001) towards the quality of life. Most participants have inadequate self-care maintenance, self-care management, and self-care confidence (score < 70), while the score of quality of life is categorized as poor. Conclusion. The self-care behaviors were limited among patients living with HF in Indonesia yet was associated with better quality of life. It is necessary to promote health related to knowledge and adherence to self-care behavior so that it can improve the quality of life of heart failure patients. This study can be used as a reference to promote self-care among patients with heart failure, it can help to enhance their quality of life.

Keywords: heart failure, self-care maintenance, self-care management, self-care confidence, quality of life

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Authors: Ya-Hui Wang

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Lower speech therapy rate of tracheostomized patient was noted in comparison with previous researches. This study is aim to shed light on the referral status of speech therapy in those patients in Taiwan. This study developed an analysis for the size and key characteristics of the population of tracheostomized in-patient in the Taiwan. Method: We analyzed National Healthcare Insurance data (The Collaboration Center of Health Information Application, CCHIA) from Jan 1 2010 to Dec 31 2010. Result: over ages 3, number of tracheostomized in-patient is directly proportional to age. A high service loading was observed in North region in comparison with other regions. Only 4.87% of the tracheostomized in-patients were referred for speech therapy, and 1.9% for swallow examination, 2.5% for communication evaluation.

Keywords: refer, speech therapy, training, rehabilitation

Procedia PDF Downloads 436

Authors: Olayinka Ariba, Abe Oudshoorn, Steve Rolfe, Carrie Anne Marshall, Deanna Befus, Jason Gilliland, Miranda Crockett, Susana Caxaj, Sarah McLean, Amy Van Berkum, Natasha Thuemler

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Background: Secure housing is a platform for health and well-being. Those who struggle with housing stability have complex life and health histories and often require some support services such as the provision of permanent supportive housing. Poor access to supportive resources creates an exacerbation of chronic homelessness, particularly affecting individuals who need immediate access to mental health and addiction supports. This paper presents the first phase of a three-part study examining how on-site support impacts housing stability for recently-re-housed persons. Method: This study utilized a community-based participatory research methodology. Twenty in-depth interviews were conducted with permanent supportive housing residents from a single-site dwelling. Interpretative description analysis was used to draw common themes and understand the experiences and challenges of housing support. Results: Three interconnected themes were identified: 1) Available and timely supports; 2) Affordability; and 3) Community, but with independence as desired. These interconnected components are helping residents transition from homelessness or long-term mental health inpatient care to live in the community. Despite some participant concerns about resident conflicts, staff availability, and affordability, this has been a welcome and successful move for most. Conclusion: Supportive housing is essential for successful tenancies as a platform for health and well-being among Canada’s most vulnerable and, from the perspective of persons recently re-housed, permanent supportive housing is a worthwhile investment.

Keywords: homelessness, supportive housing, rehoused, housing stability

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Authors: Krishna Gopal Lageju

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On 25th April 2015, a 7.6 magnitude earthquake struck Gorkha district of Nepal, which resulted over 8,790 deaths and 22,300 injuries. In addition, almost one-third of the country’s healthcare service has been disrupted. A total of 1,211 health facilities became non-operational, due to 446 completely and other 765 partially damaged. Nearly 84 percent (375 out of 446) of the completely damaged health facilities are in the 14 most affected districts. As a result, the ability of health facilities to respond to health care needs has been harshly affected. In addition, 18 health workers lost their lives and 75 are injured, which added further challenges in the delivery of health services. Thus, to address the immediate health needs in the most devastated areas, Nepal Red Cross Society (NRCS) in coordination with IFRC and Nepal Government, 8 Field hospitals established with surgical capacities, where around 492 international Emergency Response Units (ERUs) Members are mobilized for 3 months period. More than 54,000 patients have been treated in the Red Cross operated field hospitals. Trauma cases accounted 9,180 (17%) of the total patients off which 1,285 (14%) are major surgical cases. Most of the case loads 44,830 (83%) are outpatients and 9,180 patients got inpatients service. Similarly, 112 births have been performed in the field hospitals. Inpatient mortality rate remained 1.5% (21 deaths), many of them are presented with critical injuries or illnesses. No outbreak has been seen during the ERU operation. Deployment of ERUs together with national health workers are very important to address the immediate health needs of the affected communities. This will ease for transition and handover of emergency service and equipments to local provider. Likewise, capacity building of local staff as on the job training on various clinical teachings would be another important issue to look at before phasing out such services.

Keywords: trauma management, critical injuries, earthquake, health

Procedia PDF Downloads 237

Authors: Chuang-Chun Chiou

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Ageing population is a global trend; therefore the need of care service has been increasing dramatically. There are three basic forms of service delivered to the elderly: institution, community, and home. Particularly, the institutional service can be seen as an extension of medical service. The nursing home or so-called care home which is equipped with professional staff and facilities can provide a variety of service including rehabilitation service, short-term care, and long term care. Similar to hospital and other health care service, care home service do need to provide quality and cost-effective service to satisfy the dwellers. The main purpose of this paper is to show how lean thinking and service innovation can be applied to care home operation. The issues and key factors of implementing lean practice are discussed.

Keywords: lean, service improvement, SERVQUAL, care home service

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Authors: Han Chih Feng, Yi-Cheng Hou, Jing-Huei Wu

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Diabetes is a chronic disease. Nutrition knowledge and skills enable individuals with type 2 diabetes to optimize metabolic self-management and quality of life. This research studies the effect of nutritional education on diabetes inpatients in terms of their cognition, behavior, and attitude. The participants are inpatients diagnosed with diabetes at Taipei Tzu Chi Hospital. A total of 103 participants, 58 male, and 45 females, enrolled in the research between January 2018 and July 2018. The research evaluates cognition, behavior, and attitude level before and after nutritional education conducted by dietitians. The result shows significant improvement in actual consumption (2.5 ± 1.4 vs 3.8 ± 0.7; p<.001), diet control motivation (2.7 ± 0.8 vs 3.4 ± 0.6; p<.001), correct nutrition concept (1.2± 0.4 vs 2.4 ± 0.5; p<.001), learning willingness (2.7± 0.9 vs 3.4 ± 0.6; p<.001), cognitive behaviors (1.4 ± 0.5 vs 2.9 ± 0.7; p<.001). AC sugar (278.5 ± 321.5 vs 152.2 ± 49.1; p<.001) and HbA1C (10.3 ± 2.6 vs 8.6 ± 1.9; p<.001) are significant improvement after nutritional education. After nutritional education, participants oral hypoglycemic agents increased from 16 (9.2%) to 33 (19.0%), insulin decreased from 75 (43.1%) to 68 (39.1%), and hypoglycemic drugs combined with insulin decreased from 83 (47.7%) to 73 (42.0%).Further analysis shows that female inpatients have significant improvement in diet control motivation (3.91 ± 0.85 vs 4.44 ± 0.59; p<0.000), correct nutrition concept (3.24± 0.48 vs 4.47± 0.51; p<0.000), learning willingness (3.89 ± 0.86 vs 4.44 ± 0.59; p<0.000) and cognitive behaviors (2.42 ± 0.58 vs 4.02 ± 0.69; p<0.000); male inpatients have significant improvement in actual food intake (4.41± 0.92 vs 3.97 ± 0.42; p<0.000), diet control motivation (3.62 ± 0.86 vs 4.29 ± 0.62; p<0.000), correct nutrition concept (3.26 ± 0.44 vs 4.36 ± 0.49; p<0.000), learning willingness (3.72± 0.93 vs 4.33± 0.63; p<0.000) and cognitive behaviors (2.45± 0.54 vs 4.03± 0.77; p<0.000). In conclusion, nutritional education proves effective, regardless of gender, in improving an inpatient’s cognition, behavior, and attitude toward diabetes self-management.

Keywords: diabetes, nutrition education, actual consumption, diet control motivation, nutrition concept, learning willingness, cognitive behaviors

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Authors: Panos Xenos, Milton Nektarios, John Yfantopoulos

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Background: Policy makers, professional organizations and payers have introduced a variety of initiatives and reforms for the health systems worldwide, aimed at improving hospital efficiency. Their efforts are concentrated in two main categories: to constrain increasing healthcare costs and to enhance quality of services provided. Research Objectives: This study examines the efficiency of 112 Greek public hospitals for the year 2009, evaluates the importance of bootstrapping techniques and investigates the effect of contextual factors on hospital efficiency. Furthermore, the effect of qualitative evidence, on hospital efficiency is explored using data from 28 large hospitals. Methods: We applied Data Envelopment Analysis, augmented by bootstrapping techniques, to estimate efficiency scores. In order to measure the effect of environmental factors on hospital efficiency we used Tobit regression analysis. The significance of our models is evaluated using statistical tests to compare distributions. Results: The Kolmogorov-Smirnov test between the original and the bootstrap-corrected efficiency indicates that their distributions are significantly different (p-value<0.01). The environmental factors, that seem to influence efficiency, are Occupancy Rating and the ratio between Outpatient Visits and Inpatient Days. Results indicate that the inclusion of the quality variable in DEA modelling generates statistically significant variations in efficiency scores (p-value<0.05). Conclusions: The inclusion of quality variables and the use of bootstrap resampling in efficiency analysis impose a statistically significant effect on the distribution of efficiency scores. As a policy conclusion we highlight the importance of these methods on hospital efficiency analysis and, by implication, on healthcare resource allocation.

Keywords: hospitals, efficiency, quality, data envelopment analysis, Greek public hospital sector

Procedia PDF Downloads 303

Authors: Nairy Kechichian

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The original Leclerc Bridge is a covered wooden bridge that is considered a Quebec heritage structure with an index of 60, making it a very important provincial bridge from a historical point of view. It was constructed in 1927 and is in the rural area of Abitibi-Temiscamingue. It is a “town Québécois” type of structure, which is generally rare but common for covered bridges in Abitibi-Temiscamingue. This type of structure is composed of two trusses on both sides formed with diagonals, internal bracings, uprights and top and bottom chords to allow the transmission of loads. This structure is mostly known for its solidity, lightweightness, and ease of construction. It is a single-span bridge with a length of 25.3 meters and allows the passage of one vehicle at a time with a 4.22-meter driving lane. The structure is composed of 2 trusses located at each end of the deck, two gabion foundations at both ends, uprights and top and bottom chords. WSP (Williams Sale Partnership) Canada inc. was mandated by the Transport Minister of Quebec in 2019 to increase the capacity of the bridge from 5 tons to 30.6 tons and rehabilitate it, as it has deteriorated quite significantly over the years. The bridge was damaged due to material deterioration over time, exposure to humidity, high load effects and insect infestation. To allow the passage of 3 axle trucks, as well as to keep the integrity of this heritage structure, the final design chosen to rehabilitate the bridge involved adding a new deck independent from the roof structure of the bridge. Essentially, new steel beams support the deck loads and the desired vehicle loads. The roof of the bridge is linked to the steel deck for lateral support, but it is isolated from the wooden deck. The roof is preserved for aesthetic reasons and remains intact as it is a heritage piece. Due to strict traffic management obstacles, an efficient construction method was put into place, which consisted of building a temporary bridge and moving the existing roof onto it to allow the circulation of vehicles on one side of the temporary bridge while providing a working space for the repairs of the roof on the other side to take place simultaneously. In parallel, this method allowed the demolition and reconstruction of the existing foundation, building a new steel deck, and transporting back the roof on the new bridge. One of the main criteria for the rehabilitation of the wooden bridge was to preserve, as much as possible, the existing patrimonial architectural design of the bridge. The project was completed successfully by the end of 2021.

Keywords: covered bridge, wood-steel, short span, town Québécois structure

Procedia PDF Downloads 61

Authors: Parastou Kharazmi, Folke Björk

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Some of the main causes for degradation of polymeric materials are thermal aging, hydrolysis, oxidation or chemical degradation by acids, alkalis or water. The first part of this paper provides a brief summary of advances in technology, methods and specification of composite materials for relining as a rehabilitation technique for sewage systems. The second part summarizes an investigation on frequently used composite materials for relining in Sweden, the rubber filled epoxy composite and reinforced polyester composite when they were immersed in deionized water or in dry conditions, and elevated temperatures up to 80°C in the laboratory. The tests were conducted by visual inspection, microscopy, Dynamic Mechanical Analysis (DMA), Differential Scanning Calorimetry (DSC) as well as mechanical testing, three point bending and tensile testing.

Keywords: composite, epoxy, polyester, relining, sewage

Procedia PDF Downloads 338

Authors: Chueh Chi-An, Chan Hui-Ya

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Background and Aim: National Health Insurance (NHI) Administration released a new reimbursement policy for hospital patients who received a superior discharge plan on April 1, 2016. Each case could be claimed 1,500 points for fee-of service with related documents. The policy is considered a solution to help reducing the crowding in the emergency department, the length of stay of hospital, unplanned readmission rate and unplanned ER visit. This study aim is to explore the effect of the new reimbursement policy for discharge planning service in a medical center. Methods: The discharge team explained to general wards the new policy and encouraged early assessment, communication and connecting to community care for patients. They stated the benefit from the policy and asked documenting for reimbursement claiming from April to May 2016. The imbursement fee of NHI declaration from June 2015 to October 2017 was collected. The indicators included hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction were analyzed after the policy implemented. Results: The results showed that the amount of service declaration was increasing from 2 cases in February 2016 to 110 cases in October 2017, the application rate was increasing from 0.029% to 1.576% of all inpatient cases, and the average payment from NHI was around 148,500 NT dollars per month in 2017. There are no significant differences in the indicators among hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction. Conclusion: To provide a good discharge plan require a specialized case manager, the new reimbursement policy is too complicated and the total fee-of-service hospital could claim is too limited to hiring one. The results suggest more strategies combine with the new reimbursement policy will be needed.

Keywords: discharge planning, reimbursement, unplanned ER visit, readmission rate

Procedia PDF Downloads 173

Authors: M. K. Mohd Safee, W. A. B. Wan Abas, F. Ibrahim, N. A. Abu Osman, N. A. Abdul Malik

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This paper investigates the activity of the rectus femoris (RF) and biceps femoris (BF) in healthy subjects during salat (prostration) and specific exercise (squat exercise) using electromyography (EMG). A group of undergraduates aged between 19 to 25 years voluntarily participated in this study. The myoelectric activity of the muscles were recorded and analyzed. The finding indicated that there were contractions of the muscles during the salat and exercise with almost same EMG’s level. From the result, Wilcoxon’s Rank Sum test showed significant difference between prostration and squat exercise (p < 0.05) but the differences was very small; RF (8.63% MVC) and BF (11.43% MVC). Therefore, salat may be useful in strengthening exercise and also in rehabilitation programs for lower limb activities. This pilot study conducted initial research into the bio mechanical responses of human muscles in various positions of salat.

Keywords: electromyography, exercise, muscle, salat

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Authors: Syue-Wen Lin

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Objective: This article discusses the nursing experience of caring for a uterine cancer patient who experienced cardiogenic shock and was weaned off ECMO. The patient was placed on ECMO due to cardiogenic shock and initially struggled with anxiety caused by the physical discomfort from the disease and multiple medical devices, as well as the isolation in the ICU and restrictions on physical activity. Over time, the patient was able to wean off ECMO and perform daily activities and rehabilitation independently. Methods: The nursing period was from January 6 to January 9. Through observation, direct care, interviews, physical assessments, and case reviews, the intensive care team and bypass personnel conducted a comprehensive assessment using Gordon's 11 functional health patterns. The assessment identified three main nursing health problems: pain, anxiety, and decreased cardiac tissue perfusion. Results: The author consulted a psychologist to employ open communication techniques and empathetic care to build a trusting nurse-patient relationship. A patient-centered intensive cancer care plan was developed. Pain was assessed using a pain scale, and pain medications were adjusted in consultation with a pharmacist. Lavender essential oil therapy, light music, and pillows were used to distract and alleviate pain. The patient was encouraged to express feelings and family members were invited to increase visits and provide companionship to reduce the uncertainty caused by cancer and illness. Vital signs were closely monitored, and nursing interventions were provided to maintain adequate myocardial perfusion. Post-ECMO, the patient was encouraged to engage in rehabilitation and cardiopulmonary training. Conclusion: A key takeaway from the care process is the importance of observing not only the patient's vital signs but also their psychological state, especially when dealing with cancer patients on ECMO. The patient's greatest source of comfort was the presence of family, which helped alleviate anxiety. Healthcare providers play multiple critical roles as advocates, coordinators, educators, and counselors, listening to and accepting the patient’s emotional responses. The report aims to provide clinical cancer nurses with a reference to improve the quality of care and alleviate cancer-related discomfort.

Keywords: ECMO, uterine cancer, palliative care, Gordon's 11 functional health patterns

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Authors: Rajib Husain, Munirujzaman Osmani, Mohammad Shamsal Islam

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Purpose: To compare the safety, efficacy and visual outcome of phacoemulsification vs. manual small-incision cataract surgery (SICS) for the treatment of cataract in Bangladesh. Objectives: 1. To assess the Visual outcome after cataract surgery 2. To understand the post-operative complications and early rehabilitation 3. To identified which surgical procedure more attractive to the patients 4. To identify which surgical procedure is occurred fewer complications. 5. To find out the socio-economic and demographic characteristics of study patients Setting: Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh. Design: Retrospective, randomised comparison of 300 patients with visually significant cataracts. Method: The present study was designed as a retrospective hospital-based research. The sample size was 300 and study period was from July, 2012 to July, 2013 and assigned randomly to receive either phacoemulsification or manual small-incision cataract surgery (SICS). Preoperative and post-operative data were collected through a well designed collection format. Three follow-up were done; i) during discharge ii) 1-3 weeks & iii) 4-11 weeks post operatively. All preoperative and surgical complications, uncorrected and best-corrected visual acuity (BCVA) and astigmatism were taken into consideration for comparison of outcome Result: Nearly 95% patients were more than 40 years of age. About 52% patients were female, and 48% were male. 52% (N=157) patients came to operate their first eye where 48% (N=143) patients were visited again to operate their second eye. Postoperatively, five eyes (3.33%) developed corneal oedema with >10 Descemets folds, and six eyes (4%) had corneal oedema with <10 Descemets folds for Phacoemulsification surgeries. For SICS surgeries, seven eyes (4.66%) developed corneal oedema with >10 Descemets folds and eight eyes (5.33%) had corneal oedema with < 10 descemets folds. However, both the uncorrected and corrected (4-11 weeks) visual acuities were better in the eyes that had phacoemulsification (p=0.02 and p=0.03), and there was less astigmatism (p=0.001) at 4-11 weeks in the eye that had phacoemulsification. Best-corrected visual acuity (BCVA) of final follow-up 95% (N=253) had a good outcome, borderline 3.10% (N=40) and poor outcome was 1.6% (N=7). The individual surgeon outcome were closer, 95% (BCVA) in SICS and 96% (BCVA) in Phacoemulsification at 4-11 weeks follow-up respectively. Conclusion: outcome of cataract surgery both Phacoemulsification and SICS in CEITC was more satisfactory according to who norms. Both Phacoemulsification and manual small-incision cataract surgery (SICS) shows excellent visual outcomes with low complication rates and good rehabilitation. Phacoemulsification is significantly faster, and modern technology based surgical procedure for cataract treatment.

Keywords: phacoemulsification, SICS, cataract, Bangladesh, visual outcome of SICS

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Authors: Kwok Tak Kit

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Construction and demolition (C&D) waste generated in the process of urbanization which only contribute to approx. 25–35 per cent of municipal solid waste (MSW), and the action to reduce the generation of other MSW is considered more critical. Developed and cities produce a higher percentage of inorganic waste rather than organic waste. Most of the MSW was disposed in landfill, and a large number of the landfills are not effectively and efficiently operated to receive the untreated incoming waste. It is also a global problem that the demands for enhancement of basic infrastructure for waste collection, treatment, and disposal, including rehabilitation of the dump sites, is the urgent priority. This paper is to review the factors taken into consideration of waste management development in relation to circular economy development on development countries and green recovery in the post-pandemic era for further researches use.

Keywords: waste management, waste reduction, circular economy, developed countries, sustainable design goals

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Authors: Kai Pei Huang, Ting Chung Hung, Li Ching Wu

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Amyloidosis refers to a variety of conditions wherein amyloid proteins are abnormally deposited in organ or tissues and cause harm. Among the several forms of amyloidosis, the principal types of that in inpatient medical services are the AL amyloidosis (primary) and AA amyloidois (secondary). AL Amyloidois is due to deposition of protein derived from overproduction of immunoglobulin light chain in plasma cell myeloma. Furthermore, it is a systemic disorder that can present with a variety of symptoms, including heavy proteinemia and edema, heptosplenomegaly, otherwise unexplained heart failure. We reported a 78-year-old female presenting dysuria, oliguria and leg edema for several months. Laboratory data showed proteinuria (UPCR:1679.8), leukocytosis (WBC:16.2 x 10^3/uL), results of serum urea nitrogen (39mg/dL), creatinine (0.76 mg/dL), IgG (748 mg/dL.), IgA (635 mg/dL), IgM (63 mg/dL), kappa light chain(18.8 mg/dL), lambda light chain (110.0 mg/dL) and kappa/lambda ratio (0.17). Renal biopsy found amyloid fibrils in glomerular mesangial area, and Congo red stain highlights amyloid deposition in glomeruli. Additional lab studies included serum protein electrophoresis, which shows a major monoclonal peak in β region and minor small peak in gamma region, and the immunotyping studies for serum showed two IgA/λ type. We treated sample with beta-mercaptoethanol which reducing the polymerized immunoglobulin to clarify two IgA/λ are secreted from the same plasma cell clone in bone marrow. Later examination confirmed it existed plasma cell infiltration in bone marrow, and the immunohistochemical staining showed monotypic for λ light chain and are positive for IgA. All findings mentioned above reveal it is a case of plasma cell myeloma with λ Light Chain Amyloidosis.

Keywords: amyloidosis, immunoglobulin light chain, plasma cell myeloma, serum protein electrophoresis

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Authors: Yinjun Tu, Qiang Fang, Glenn I. Matthews, Shuenn-Yuh Lee

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This paper reports an efficient and rigorous self-adaptive stimulus artifacts removal approach for a mixed surface EMG (Electromyography) and stimulus signal during muscle stimulation. The recording of EMG and the stimulation of muscles were performing simultaneously. It is difficult to generate muscle fatigue feature from the mixed signal, which can be further used in closed loop system. A self-adaptive method is proposed in this paper, the stimulation frequency was calculated and verified firstly. Then, a mask was created based on this stimulation frequency to remove the undesired stimulus. 20 EMG signal recordings were analyzed, and the ANOVA (analysis of variance) approach illustrated that the decreasing trend of median power frequencies was successfully generated from the 'cleaned' EMG signal.

Keywords: EMG, FES, stimulus artefacts, self-adaptive

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Authors: Ma. Cecilia D. Licuan

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The pandemic situation continues to affect the lives of many people, including children with disabilities and their families, globally, especially in developing countries like the Philippines. The operations of health programs, industries, and economic sectors, as well as academic training institutions, are still challenged in terms of operations and delivery of services. The academic community of the Physical Therapy program is not spared by this circumstance. The restriction posted by the quarantine policies nearly terminated the onsite delivery of training programs for the senior internship level, which challenged the academic institutions to implement flexible learning programs to ensure the continuity of the instructional and learning processes with full consideration of safety and compliance to health protocols. This study aimed to develop a benchmark model that can be used by tertiary-level health institutions in the implementation of the Pediatric Senior Clinical Internship Training Program using Telerehabilitation. It is a descriptive-qualitative paper that utilized documentary analysis and focused on explaining the design, development, and implementation processes used by De La Salle Medical and Health Sciences Institute – College of Rehabilitation Sciences (DLSMHSI-CRS) Physical Therapy Department in its Pediatric Cluster Senior Clinical Internship Training Program covering the pandemic years spanning from the academic year 2020- 2021 to present anchored on needs analysis based on documentary reviews. Results of the study yielded the determination of the Pediatric Telerehabilitation Model; declaration of developed training program outcomes and thrusts and content; explanation of the process integral to the training program’s pedagogy in implementation; and the evaluation procedures conducted for the program. Since the study did not involve human participants, ethical considerations on the use of documents for review were done upon the endorsement of the management of the DLSMHSI-CRS to conduct the study. This paper presents the big picture of how a tertiary-level health sciences institution in the Philippines embraced the senior clinical internship challenges through the operations of its telerehabilitation program. It specifically presents the design, development and implementation processes used by De La Salle Medical and Health Sciences Institute – College of Rehabilitation Sciences Physical Therapy Department in its Pediatric Cluster Senior Clinical Internship Training Program, which can serve as a benchmark model for other institutions as they continue to serve their stakeholders amidst the pandemic.

Keywords: pediatric physical therapy, telerehabilitation, clinical internship, pandemic

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Authors: Jeremiah Mutamba

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Water is a critical resource for sustainable economic growth and social development. It enables societies to thrive and influences every urban center’s future. Thus, water must always be available in the right quantity and quality. However, in South Africa - a known physically water scarce nation – the future of sustainable urban supply of water may be in jeopardy. The country facing a water crisis influenced by insufficient infrastructure investment and maintenance, recurrent droughts and climate variation, human induced water quality deterioration, as well as growing lack of technical capacity in water institutions, particularly local municipalities. Aside of the eight metropolitan municipalities for the country, most municipalities struggle with provision of reliable water to their citizens. These municipalities contend with having now capable engineers, aging infrastructure with concomitant high system water losses (of 30% and upwards), coupled with growing water demand from expanding industries and population growth. Also, a significant portion (44%) of national water treatment plants are in critically poor condition, requiring urgent rehabilitation. Municipalities also struggle to raise funding to instate projects. All these factors militate against sustainable urban water supply in the country. Urgent mitigation measures are required. This paper seeks to review the extent of the current water supply challenges in South Africa’s urban centers, including searching for practical and cost-effective measures. The study followed a qualitative approach, combining desktop literature research, interviews with key sector stakeholders, and a workshop. Phenomenological data analysis technique was used to study and examine interview data and secondary desktop data. Preliminary findings established the building of technical or engineering capacity, reversal of the high physical water losses, rehabilitation of poor condition and dysfunctional water treatment works, diversification of water resource mix, and water scarcity awareness programs as possible practical solutions. Other proposed solutions include the use of performance-based or value-based contracting to fund initiatives to reduce high system water losses. Out-come based arrangements for revenue increasing water loss reduction projects were considered more practical in funding-stressed local municipalities. If proactively implemented in an integrated manner, these proposed solutions are likely to ensure sustainable urban water supply in South African urban centers in the future.

Keywords: sustainable, water scarcity, water supply, South Africa

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Authors: Hilal Keklicek, Fatih Erbahceci, Elif Kirdi, Ali Yalcin, Semra Topuz, Ozlem Ulger, Gul Sener

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Objectives and Goals: The stride-to-stride fluctuations in gait is a determinant of qualified locomotion as known as gait variability. Gait variability is an important predictive factor of fall risk and useful for monitoring the effects of therapeutic interventions and rehabilitation. Comparison of gait variability in individuals with trans-tibial lower limb loss and trans femoral lower limb loss was the aim of the study. Methods: Ten individuals with traumatic unilateral trans femoral limb loss(TF), 12 individuals with traumatic transtibial lower limb loss(TT) and 12 healthy individuals(HI) were the participants of the study. All participants were evaluated with treadmill. Gait characteristics including mean step length, step length variability, ambulation index, time on each foot of participants were evaluated with treadmill. Participants were walked at their preferred speed for six minutes. Data from 4th minutes to 6th minutes were selected for statistical analyses to eliminate learning effect. Results: There were differences between the groups in intact limb step length variation, time on each foot, ambulation index and mean age (p < .05) according to the Kruskal Wallis Test. Pairwise analyses showed that there were differences between the TT and TF in residual limb variation (p=.041), time on intact foot (p=.024), time on prosthetic foot(p=.024), ambulation index(p = .003) in favor of TT group. There were differences between the TT and HI group in intact limb variation (p = .002), time on intact foot (p<.001), time on prosthetic foot (p < .001), ambulation index result (p < .001) in favor of HI group. There were differences between the TF and HI group in intact limb variation (p = .001), time on intact foot (p=.01) ambulation index result (p < .001) in favor of HI group. There was difference between the groups in mean age result from HI group were younger (p < .05).There were similarity between the groups in step lengths (p>.05) and time of prosthesis using in individuals with lower limb loss (p > .05). Conclusions: The pilot study provided basic data about gait stability in individuals with traumatic lower limb loss. Results of the study showed that to evaluate the gait differences between in different amputation level, long-range gait analyses methods may be useful to get more valuable information. On the other hand, similarity in step length may be resulted from effective prosthetic using or effective gait rehabilitation, in conclusion, all participants with lower limb loss were already trained. The differences between the TT and HI; TF and HI may be resulted from the age related features, therefore, age matched population in HI were recommended future studies. Increasing the number of participants and comparison of age-matched groups also recommended to generalize these result.

Keywords: lower limb loss, amputee, gait variability, gait analyses

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Authors: M. K. Mohd Safee, W. A. B. Wan Abas, F. Ibrahim, N. A. Abu Osman, N. A Abdul Malik

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This paper investigates the activity of the rectus femoris (RF) and biceps femoris (BF) in healthy subjects during salat (prostration) and specific exercise (squat exercise) using electromyography (EMG). A group of undergraduates aged between 19 to 25 years voluntarily participated in this study. The myoelectric activity of the muscles were recorded and analyzed. The finding indicated that there were contractions of the muscles during the salat and exercise with almost same EMG’s level. From the result, Wilcoxon’s Rank Sum test showed significant difference between prostration and squat exercise (p<0.05) but the differences was very small; RF (8.63%MVC) and BF (11.43%MVC). Therefore, salat may be useful in strengthening exercise and also in rehabilitation programs for lower limb activities. This pilot study conducted initial research into the biomechanical responses of human muscles in various positions of salat.

Keywords: electromyography, exercise, muscle, salat

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Authors: Phillipa Evans, Christopher Trotter

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Aims: This study aims to examine the effectiveness of a practice skills framework implemented in three youth detention centres in Juvenile Justice in New South Wales (NSW), Australia. The study is supported by a grant from and Australian Research Council and NSW Juvenile Justice. Recent years have seen a number of incidents in youth detention centres in Australia and other places. These have led to inquiries and reviews with some suggesting that detention centres often do not even meet basic human rights and do little in terms of providing opportunities for rehabilitation of residents. While there is an increasing body of research suggesting that community based supervision can be effective in reducing recidivism if appropriate skills are used by supervisors, there has been less work considering worker skills in youth detention settings. The research that has been done, however, suggest that teaching interpersonal skills to youth officers may be effective in enhancing the rehabilitation culture of centres. Positive outcomes have been seen in a UK detention centre for example, from teaching staff to do five-minute problem-solving interventions. The aim of this project is to examine the effectiveness of training and coaching youth detention staff in three NSW detention centres in interpersonal practice skills. Effectiveness is defined in terms of reductions in the frequency of critical incidents and improvements in the well-being of staff and young people. The research is important as the results may lead to the development of more humane and rehabilitative experiences for young people. Method: The study involves training staff in core effective practice skills and supporting staff in the use of those skills through supervision and de-briefing. The core effective practice skills include role clarification, pro-social modelling, brief problem solving, and relationship skills. The training also addresses some of the background to criminal behaviour including trauma. Data regarding critical incidents and well-being before and after the program implementation are being collected. This involves interviews with staff and young people, the completion of well-being scales, and examination of departmental records regarding critical incidents. In addition to the before and after comparison a matched control group which is not offered the intervention is also being used. The study includes more than 400 young people and 100 youth officers across 6 centres including the control sites. Data collection includes interviews with workers and young people, critical incident data such as assaults, use of lock ups and confinement and school attendance. Data collection also includes analysing video-tapes of centre activities for changes in the use of staff skills. Results: The project is currently underway with ongoing training and supervision. Early results will be available for the conference.

Keywords: custody, practice skills, training, youth workers

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Authors: Avirup Chowdhury, Angus K. McFadyen, Linsey Batchelor

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Blood cultures (BCs) are an important aspect of management of the septic patient, identifying the underlying pathogen and its antibiotic sensitivities. However, while the current literature outlines indications for initial BCs to be taken, there is little guidance for repeat sampling in the following 5-day period and little information on how antibiotic use can affect the usefulness of this investigation. A retrospective cohort study was conducted using inpatients who had undergone 2 or more BCs within 5 days between April 2016 and April 2017 at a 400-bed hospital in the west of Scotland and received antibiotic therapy between the first and second BCs. The data for BC sampling was collected from the electronic microbiology database, and cross-referenced with data from the hospital electronic prescribing system. Overall, 283 BCs were included in the study, taken from 92 patients (mean 3.08 cultures per patient, range 2-10). All 92 patients had initial BCs, of which 83 were positive (90%). 65 had a further sample within 24 hours of commencement of antibiotics, with 35 positive (54%). 23 had samples within 24-48 hours, with 4 (17%) positive; 12 patients had sampling at 48-72 hours, 12 at 72-96 hours, and 10 at 96-120 hours, with none positive. McNemar’s Exact Test was used to calculate statistical significance for patients who received blood cultures in multiple time blocks (Initial, < 24h, 24-120h, > 120h). For initial vs. < 24h-post BCs (53 patients tested), the proportion of positives fell from 46/53 to 29/53 (one-tailed P=0.002, OR 3.43, 95% CI 1.48-7.96). For initial vs 24-120h (n=42), the proportions were 38/42 and 4/42 respectively (P < 0.001, OR 35.0, 95% CI 4.79-255.48). For initial vs > 120h (n=36), these were 33/36 and 2/36 (P < 0.001,OR ∞). These were also calculated for a positive in initial or < 24h vs. 24-120h (n=42), with proportions of 41/42 and 4/42 (P < 0.001, OR 38.0, 95% CI 5.22-276.78); and for initial or < 24h vs > 120h (n=36), with proportions of 35/36 and 2/36 respectively (P < 0.001, OR ∞). This data appears to show that taking an initial BC followed by a BC within 24 hours of antibiotic commencement would maximise blood culture yield while minimising the risk of false negative results. This could potentially remove the need for as many as 46% of BC samples without adversely affecting patient care. BC yield decreases sharply after 48 hours of antibiotic use, and may not provide any clinically useful information after this time. Further multi-centre studies would validate these findings, and provide a foundation for future health policy generation.

Keywords: antibiotics, blood culture, efficacy, inpatient

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Authors: Thuraya Ahmed Hamood Al Shidhani

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Sports Medicine injuries are very common in primary health care. It is not necessary related to direct trauma, but it could be because of repetitive stress and overuse injuries. Knowledge of Primary Health care providers about the common sports medicine injuries and when to refer to a specialist is essential. Common sports injuries are muscle strain, joint sprain, bone bruise, Patellofemoral pain syndrome, Anterior cruciate ligament injuries, meniscal injuries, ankle ligaments injuries, concussion, Rotator cuff tendinosis/impingement syndrome, lateral and medial epicondylitis and fractures. Systematic approach is very useful in evaluation of sports injuries. RICE is important in initial management. Physiotherapy is essential for rehabilitation. Definitive Management is dependent on patient’s condition and function.

Keywords: common, sports medicine injuries, primary health care, injuries

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Authors: Jie Bai, Yongsheng Gao, Shengxin Wang, Jie Zhao

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Through the establishment of the elbow biomechanical model, it can provide theoretical guide for rehabilitation therapy on the upper limb of the human body. A biomechanical model of the elbow joint can be built by the connection of muscle force model and elbow dynamics. But there are many undetermined coefficients in the model like the optimal joint angle and optimal muscle force which are usually specified as the experimental parameters of other workers. Because of the individual differences, there is a certain deviation of the final result. To this end, the RMS value of the deviation between the actual angle and calculated angle is considered. A set of coefficients which lead to the minimum RMS value will be chosen to be the optimal parameters. The direct search method and the conjugacy search method are used to get the optimal parameters, thus the model can be more accurate and mode adaptability.

Keywords: elbow biomechanical model, RMS, direct search, conjugacy search

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Authors: Archil Undilashvili, Ketevan Stvilia, Dustin Gilbreath, Giorgi Dzneladze, Gordon Charchward

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Introduction: In recent years, diverse types of wheelchairs, both local production and imported, have been made available on the Georgian market for wheelchair users. Some types of wheelchairs are sold together with a service package, while the others, including the State Program, Supported locally-produced ones, don’t provide adjustment and maintenance service packages to users. Within the USAID Physical Rehabilitation Project in Georgia, a study was conducted to assess the impact of the wheelchair service provision in line with the WHO guidelines on the health and overall satisfaction of wheelchair users in Georgia. Methodology: A cross-sectional survey was conducted in May 2021. A structured questionnaire was used for telephone interviews that, along with socio-demographic characteristics, included questions for assessment of accessibility, availability, timeliness, cost and quality of wheelchair services received. Out of 1060 individuals listed in the census of wheelchair users, 752 were available for interview, with an actual response rate of 73.4%. 552 wheelchair users (31%) or their caregivers (69%) agreed to participate in the survey. In addition to using descriptive statistics, the study used multivariate matching of wheelchair users who received wheelchair services and who did not (control group). In addition, to evaluate satisfaction with service provision, respondents were asked to assess services. Findings: The majority (67%) of wheelchair users included in the survey were male. The average age of participants was 43. The three most frequently named reasons for using a wheelchair were cerebral palsy (29%), followed by stroke (18%), and amputation (12%). Users have had their current chair for four years on average. Overall, 60% of respondents reported that they were assessed before providing a wheelchair, but only half of them reported that their preferences and needs were considered. Only 13% of respondents had services in line with WHO guidelines and only 22% of wheelchair users had training when they received their current chair. 16% of participants said they had follow-up services, and 41% received adjustment services after receiving the chair. A slight majority (56%) of participants were satisfied with the quality of service provision and the service provision overall. Similarly, 55% were satisfied with the accessibility of service provision. A slightly larger majority (61%) were satisfied with the timeliness of service provision. The matching analysis suggests that users that received services in line with WHO guidelines were more satisfied with their chairs (the difference 17 point/0-100 scale) and they were four percentage points less likely to have health problems attributed to the chair. The regression analysis provides a similar finding of a 21 point increase in satisfaction attributable to services. Conclusion: The provision of wheelchair services in line with WHO guidelines and with follow-up services is likely to have a positive impact on the daily lives of wheelchair users in Georgia. Wheelchair services should be institutionalized as a standard component of wheelchair provision in Georgia.

Keywords: physical rehabilitation, wheelchair users, persons with disabilities, wheelchair production

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Authors: Matthew J. B. Wilson

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Disaster Risk Reduction relies heavily on the effective cooperation of both humanitarian and development actors, particularly in the wake of a disaster, implementing lasting recovery measures that better protect communities from disasters to come. This can be seen to fit within a broader discussion around integrating humanitarian and development work stretching back to the 1980s. Over time, a number of key concepts have been put forward, including Linking Relief, Rehabilitation, and Development (LRRD), Early Recovery (ER), ‘Build Back Better’ (BBB), and the most recent ‘Humanitarian-Development-Peace Nexus’ or ‘Triple Nexus’ (HDPN) to define these goals and relationship. While this discussion has evolved greatly over time, from a continuum to a more integrative synergistic relationship, there remains a lack of consensus around how to describe it, and as such, the reality of effectively closing this gap has yet to be seen. The objective of this research was twofold. First, to map these four identified concepts (LRRD, ER, BBB & HDPN) used in the literature since 1995 to understand the overall trends in how this relationship is discussed. Second, map articles reference a combination of these concepts to understand their interrelationship. A scoping review was conducted for each concept identified. Results were gathered from Google Scholar by firstly inputting specific boolean search phrases for each concept as they related specifically to disasters each year since 1995 to identify the total number of articles discussing each concept over time. A second search was then done by pairing concepts together within a boolean search phrase and inputting the results into a matrix to understand how many articles contained references to more than one of the concepts. This latter search was limited to articles published after 2017 to account for the more recent emergence of HDPN. It was found that ER and particularly BBB are referred to much more widely than LRRD and HDPN. ER increased particularly in the mid-2000’s coinciding with the formation of the ER cluster, and BBB, whilst emerging gradually in the mid-2000s due to its usage in the wake of the Boxing Day Tsunami, increased significantly from about 2015 after its prominent inclusion in Sendai Framework. HDPN has only just started to increase in the last 4-5 years. In regards to the relationship between concepts, it was found the vast majority of all concepts identified were referred to in isolation from each other. The strongest relationship was between LRRD and HDPN (8% of articles referring to both), whilst ER-BBB and ER-HDPN both were about 3%, LRRD-ER 2%, and BBB-HDPN 1% and BBB-LRRD 1%. This research identified a fundamental issue around the lack of consensus and even awareness of different approaches referred to within academic literature relating to integrating humanitarian and development work. More research into synthesizing and learning from a range of approaches could work towards better closing this gap.

Keywords: build back better, disaster risk reduction, early recovery, linking relief rehabilitation and development, humanitarian development integration, humanitarian-development (peace) nexus, recovery, triple nexus

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Authors: Induja R. Nimma, Anand Reddy Maligireddy, Artur Schneider, Melissa Lyle

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Background: Although heart failure is one of the most common causes of hospitalization in adult patients, there is limited knowledge on outcomes following initial hospitalization for COVID-19 with heart failure (HCF-19). We felt it pertinent to analyze 30-day readmission causes and outcomes among patients with HCF-19 using the United States using real-world big data via the National readmission database. Objective: The aim is to describe the rate and causes of readmissions and morbidity of heart failure with coinciding COVID-19 (HFC-19) in the United States, using the 2020 National Readmission Database (NRD). Methods: A descriptive, retrospective study was conducted on the 2020 NRD, a nationally representative sample of all US hospitalizations. Adult (>18 years) inpatient admissions with COVID-19 with HF and readmissions in 30 days were selected based on the International Classification of Diseases-Tenth Revision, Procedure Code. Results: In 2020, 2,60,372 adult patients were hospitalized with COVID-19 and HF. The median age was 74 (IQR: 64-83), and 47% were female. The median length of stay was 7(4-13) days, and the total cost of stay was 62,025 (31,956 – 130,670) United States dollars, respectively. Among the index hospital admissions, 61,527 (23.6%) died, and 22,794 (11.5%) were readmitted within 30 days. The median age of patients readmitted in 30 days was 73 (63-82), 45% were female, and 1,962 (16%) died. The most common principal diagnosis for readmission in these patients was COVID-19= 34.8%, Sepsis= 16.5%, HF = 7.1%, AKI = 2.2%, respiratory failure with hypoxia =1.7%, and Pneumonia = 1%. Conclusion: The rate of readmission in patients with heart failure exacerbations is increasing yearly. COVID-19 was observed to be the most common principal diagnosis in patients readmitted within 30 days. Complicated hypertension, chronic pulmonary disease, complicated diabetes, renal failure, alcohol use, drug use, and peripheral vascular disorders are risk factors associated with readmission. Familiarity with the most common causes and predictors for readmission helps guide the development of initiatives to minimize adverse outcomes and the cost of medical care.

Keywords: Covid-19, heart failure, national readmission database, readmission outcomes

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