Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.
Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.
Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).
Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix Children’s Hospital, and uses a qualitative analysis of three semi-structured interviews with currently employed Child Life Specialists to understand and analyze the use of medical play, a form of play intervention with a medical theme or medical equipment. We explore the goals and benefits of medical play for hospitalized pediatric patients, the process of using medical play as an intervention, including the activity design process, the assessments and adjustments made throughout the child’s hospitalization, and the considerations and limitations to implementing medical play activities. Ultimately, we found that the element of fun that defines play can be channeled into medical play activities implemented by skilled Child Life Specialists, who are experts in their field, in clinical settings to promote several different and beneficial goals, including pediatric patient coping.
Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix Children’s Hospital, and uses a qualitative analysis of three semi-structured interviews with currently employed Child Life Specialists to understand and analyze the use of medical play, a form of play intervention with a medical theme or medical equipment. We explore the goals and benefits of medical play for hospitalized pediatric patients, the process of using medical play as an intervention, including the activity design process, the assessments and adjustments made throughout the child’s hospitalization, and the considerations and limitations to implementing medical play activities. Ultimately, we found that the element of fun that defines play can be channeled into medical play activities implemented by skilled Child Life Specialists, who are experts in their field, in clinical settings to promote several different and beneficial goals, including pediatric patient coping.
Background: Vulnerability mapping based on vulnerability indices is a pragmatic approach for highlighting the areas in a city where people are at the greatest risk of harm from heat, but the manner in which vulnerability is conceptualized influences the results.
Objectives: We tested a generic national heat-vulnerability index, based on a 10-variable indicator framework, using data on heat-related hospitalizations in Phoenix, Arizona. We also identified potential local risk factors not included in the generic indicators.
Methods: To evaluate the accuracy of the generic index in a city-specific context, we used factor scores, derived from a factor analysis using census tract–level characteristics, as independent variables, and heat hospitalizations (with census tracts categorized as zero-, moderate-, or highincidence) as dependent variables in a multinomial logistic regression model. We also compared the geographical differences between a vulnerability map derived from the generic index and one derived from actual heat-related hospitalizations at the census-tract scale.
Results: We found that the national-indicator framework correctly classified just over half (54%) of census tracts in Phoenix. Compared with all census tracts, high-vulnerability tracts that were misclassified by the index as zero-vulnerability tracts had higher average income and higher proportions of residents with a duration of residency < 5 years.
Conclusion: The generic indicators of vulnerability are useful, but they are sensitive to scale, measurement, and context. Decision makers need to consider the characteristics of their cities to determine how closely vulnerability maps based on generic indicators reflect actual risk of harm.