Effects of revisions to the health insurance system on the recovery-phase rehabilitation ward

In the present study, we investigated the effects of revisions to the medical fee system made in April 2006 on the recovery-phase rehabilitation ward of our hospital. Subjects were patients admitted to the recovery-phase rehabilitation ward of our hospital between April 1, 2005 and September 30, 2006, and were discharged. Patients admitted between April 1, 2005 and March 31, 2006 were allocated to the pre-revision group and those admitted between April 1, 2006 and September 30, 2006 to the post-revision group. Their medical charts were investigated for comparison of the mean age, duration of hospitalization, and outcome.A total of 126 patients were allocated to the pre-revision group, and 72 to the post-revision group. The number of days from onset to admission to the recovery-phase rehabilitation ward was 41.3 days in the pre-revision group and 26.1 days in the post-revision group, while the duration of hospitalization was 71.4 days in the former group and 41.9 days in the latter. The outcomes were transfer to homecare/discharge to home in 84 patients (67%) and transfer to another department in our hospital in six patients (5%) in the pre-revision group, and 43 patients (60%) and 14 patients (19%), respectively, in the post-revision group. No significant differences in FIM were found between the two groups.The effects of the medical fee system revisions made in April 2006 on the recovery-phase rehabilitation ward of our hospital included shortening of the number of days between onset and admission, duration of hospitalization, increased transfer to other departments, and decreased rates of transfer to homecare/discharge to home. These findings indicate the importance of systemic management and team-based approaches for enabling more efficient rehabilitation

Assessment of chest movements in tetraplegic patients using a three-dimensional motion analysis system

We used optoelectronic plethysmography (OEP) to evaluate the effects of posture on chest and abdominal movements during respiration in patients with chronic-stage complete spinal cord injuries. The subjects were five cervical injury patients (male, C4-C8 injury, American Spinal Injury Association Impairment Scale grade A) and five healthy people matched to each of the cervical injury patients for age, height, and weight. The chest wall movement each of the subjects was recorded using OEP during six quiet breathing and three deep breathing periods in each of the following positions: supine, with the trunk elevated to 30°, and with the trunk elevated to 60°. Data on the chest wall volume and compartment volumes (upper thorax, lower thorax, abdomen) were then compared among the postures. During quiet breathing in the tetraplegic patients, the change in upper thorax volume was smaller at the end of inhalation than at the end of exhalation, presenting as a paradoxical breathing pattern. During deep breathing in the tetraplegic patients, abdominal volume accounted for a large portion of the change in total chest wall volume. Posture affected the recorded abdominal volume; volume was greatest in the supine position and decreased as the posture became more upright

Investigation into the safety of driving by individuals with higher brain dysfunction

Dangerous driving by drivers with diseases or disabilities such as dementia, epilepsy, or higher brain dysfunction is viewed as a problem In Worldwide. Given that the majority of such cases of dangerous driving are caused by impairments to cognitive function resulting from these conditions, there is an urgent need to create systems to detect drivers with cognitive functional disability and develop criteria for safe resumption of driving. Because driving would understandably be extremely dangerous for people with higher brain dysfunction, particularly in cases of attention dysfunction, we first examined the correlation between the Clinical Assessment of Attention (CAT), a theoretical task offering an index of attention function, and the cathode ray tube (CRT) driving aptitude test. We then examined correlations between CRT total score and CRT sub-scores. Only the time required for the position Stroop test had a moderate correlation (r=-0.43, p<0.01) with CRT total score. Correlations between CRT total score and sub-scores relating to reaction speed showed a strong correlation. Other than reaction speed, items with significant moderate to strong correlations were also seen in the maintenance of moderate mental tension, attention distribution and situation processing skill. The present results show a correlation between CAT score and CRT total score, indicating that CRT total score places relative weights on speed of information processing and suppression of stereotypes, representing a very meaningful result