Hospital discharge planning: a qualitative study of new-graduate physiotherapists' experiences

Purpose: Discharge planning constitutes a large part of a physiotherapist's role when working in hospital settings. The challenges of decision-making relating to discharge planning have been identified by experienced physiotherapists. Despite known challenges associated with the transition from student to clinician, the experiences of new-graduates undertaking discharge planning are largely unknown. Therefore, this study aimed to explore:1)    new-graduate physiotherapists' experiences of discharge planning in hospital settings, and2)    the influence of pre-professional training on their perceived preparedness for discharge planning.Design: A qualitative general inductive approach using semi-structured interviews. New-graduate physiotherapists (n = 14) working in hospital settings were recruited.Finding: Four themes were generated: 1) responding to the pressures associated with discharging patients, 2) complex decision-making, 3) the role of the interprofessional team, and 4) desiring additional context and complexity from pre-professional training.Practice Implications: The study has identified that new-graduates underestimate the extent to which discharge planning features in their roles within hospital settings, and are unaware of the interprofessional practice required. Whilst they felt that their pre-professional training provides the technical skills required for their roles, they felt that they were not prepared for their role within the broader healthcare system, nor the complexity of clinical practice. This study encourages education providers to emphasise the role of physiotherapists within the broader health care system, through highlighting contexts where physiotherapy knowledge can be applied (i.e., discharge planning) and understanding the role of the physiotherapist within the interprofessional team.Limitations: Important perspectives of mentors and other members of the interprofessional team involved in discharge planning have not been included in this study which may have impacted the interpretation of the results

Left Ventricular Sphericity Index is a reproducible bedside echocardiographic measure of geometric change between acute phase Takotsubo's syndrome and acute anterior myocardial infarction

Background: Left ventricular sphericity index (LVSI) is a simple, quick and reproducible measure to evaluate LV geometric changes. The aim of our study was to evaluate the utility of LVSI as a rapid discrimination tool in two disease processes; Takotsubo’s Syndrome (TS) and Anterior Myocardial Infarction (AMI), in the absence of significant left ventricular systolic dysfunction. Methods: Consecutive patients with acute phase TS admitted to our institution (Jan 2013 - Dec 2018) were evaluated (n=66). Patients with a comprehensive two-dimensional transthoracic echocardiogram were included in primary analysis (n=50) and age-matched with a cohort of patients with acute anterior AMI (n=50). Appraisal of demographic, clinical and echocardiographic parameters of patients was undertaken. Biplane LVSI was calculated as an average of the short- and long-axis length in the 4- and 2-chamber apical views. Results: A total of 50 TS patients (64.3±13.7 years, 18% men) were matched with 50 AMI (62.10±12.84 years, 74% men) patients. There was no significant difference in baseline cardiovascular risk factors other than diabetes mellitus (AMI 34% vs TS 17%, p = 0.034). There was also no difference in LV mass (p=0.10) or LVEF (p=0.52) between the two groups. Interestingly, there was a significant difference in mean LVSI between TS (0.60±0.06) vs AMI (0.52±0.07) (p<0.01) reflecting a more spherical shaped left ventricle in the acute TS group. Conclusions: LVSI is reflective of geometric changes in the left ventricle and may be helpful as a rapid and reproducible diagnostic tool in differentiating between TS and AMI in the acute phase

The Effectiveness of Exercise Interventions Supported by Telerehabilitation For Recently Hospitalized Adult Medical Patients: A Systematic Review

Objective: To evaluate the effectiveness of exercise interventions delivered via telerehabilitation (via videoconference) for recently hospitalized adult medical patients. Data sources: A search was undertaken across six databases for English language publications from inception to May 2020. Methods: Studies were selected if they included an exercise intervention for recently hospitalized adults, delivered by a physiotherapist via videoconference. Two reviewers independently screened 1,122 articles (21 full text screening) and assessed methodological quality using the Downs and Black Checklist. A narrative synthesis of the included studies was undertaken. Results: Three studies met eligibility criteria involving 201 participants with chronic heart failure or chronic obstructive pulmonary disease. Findings demonstrated limited evidence supporting the effectiveness of exercise delivered via telerehabilitation in improving physical function and patient reported quality of life outcomes in recently hospitalized medical patients. Telerehabilitation in this setting was also associated with high attendance rates and patient satisfaction. Conclusions: Findings provide preliminary support for the benefits of exercise interventions delivered via telerehabilitation for recently hospitalized medical patients. Results do need to be interpreted with caution as further high-quality studies specific to this method of exercise intervention delivery are needed

Perovskite-polymer composite cross-linker approach for highly-stable and efficient perovskite solar cells.

Manipulation of grain boundaries in polycrystalline perovskite is an essential consideration for both the optoelectronic properties and environmental stability of solar cells as the solution-processing of perovskite films inevitably introduces many defects at grain boundaries. Though small molecule-based additives have proven to be effective defect passivating agents, their high volatility and diffusivity cannot render perovskite films robust enough against harsh environments. Here we suggest design rules for effective molecules by considering their molecular structure. From these, we introduce a strategy to form macromolecular intermediate phases using long chain polymers, which leads to the formation of a polymer-perovskite composite cross-linker. The cross-linker functions to bridge the perovskite grains, minimizing grain-to-grain electrical decoupling and yielding excellent environmental stability against moisture, light, and heat, which has not been attainable with small molecule defect passivating agents. Consequently, all photovoltaic parameters are significantly enhanced in the solar cells and the devices also show excellent stability

DIVAD: A Dynamic and Interactive Visual Analytical Dashboard for Exploring and Analyzing Transport Data

The advances in location-based data collection technologies such as GPS, RFID etc. and the rapid reduction of their costs provide us with a huge and continuously increasing amount of data about movement of vehicles, people and goods in an urban area. This explosive growth of geospatially-referenced data has far outpaced the planner-s ability to utilize and transform the data into insightful information thus creating an adverse impact on the return on the investment made to collect and manage this data. Addressing this pressing need, we designed and developed DIVAD, a dynamic and interactive visual analytics dashboard to allow city planners to explore and analyze city-s transportation data to gain valuable insights about city-s traffic flow and transportation requirements. We demonstrate the potential of DIVAD through the use of interactive choropleth and hexagon binning maps to explore and analyze large taxi-transportation data of Singapore for different geographic and time zones