Effect of Contacting Surface on the Performance of Thin-Film Force and Pressure Sensors

Flexible force and pressure sensors are important for assessing the wear comfort of tightly fitting apparel. Their accuracy and repeatability depend on the sensor itself and the contacting surface. Measurements of the contact pressure on soft surfaces like human skin tend to be erroneous, which could be due to incorrect sensor calibrations. This study aims to examine the effects of human body parameters such as the hardness and temperature of the contacting surface by using a custom-made calibration setup and investigating the incorporation of rigid discs on the sensor surface. Two commercial force sensors, FlexiForce and SingleTact, and one pressure sensor, Pliance X, are used in the investigation. The findings reveal that adding rigid discs on both sides of the force sensors improves their sensitivity. Systematic calibration has been performed on the surfaces with different temperatures and hardness. The results show that FlexiForce and Pliance X tend to be affected by the changes in surface temperature and surface hardness. Prolonged testing time shows that the time dependence of SingleTact and Pliance X sensor is lower, which suggests that they are more suitable for lengthier evaluations in which interface pressure is exerted on the human body. In brief, sensor attachment and proper calibration should be thoroughly considered before using sensors for applications on soft surfaces, like the human body.

A pilot study to examine the feasibility and acceptability of a community model for exercise prescription for patients with chronic disease

1. A model of community care for chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) that incorporates exercise prescription is lacking, although the benefits of exercise for these diseases are established. 2. Group programmes incorporating exercise, disease education, and social support consisting of weekly sessions for 12 weeks were designed for COPD and CHF patients, in groups of 8 to 10. A home exercise programme was also prescribed. 3. This model was feasible, enjoyed good compliance, improved symptoms and measures of psychosocial outcome for both disease and improved exercise tolerance in the CHF group. 4. This model could be further developed as an integral part of community management for patients with chronic diseases.

Factors predicting stroke disability at discharge: a study of 793 Chinese

OBJECTIVE

To identify factors predicting stroke disability at discharge in a Chinese population.

DESIGN

Retrospective analysis of data collected from stroke patients.

SETTING

A 25-bed stroke rehabilitation unit in Hong Kong.

PARTICIPANTS

A total of 793 Chinese patients with acute stroke consecutively admitted for inpatient rehabilitation.

INTERVENTIONS

All patients received traditional rehabilitation therapies including physical, occupational, and speech therapies when appropriate.

MAIN OUTCOME MEASURES

Disability was measured with the Barthel index (BI), and mild disability at discharge was defined as a BI score of > or =15. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed.

RESULTS

Logistic regression analysis revealed that a BI score of > or = 15 points at admission strongly predicted that the patient's BI at discharge would be > or =15. For those whose BI score at admission was less than 15, these factors correlated negatively with a discharge BI of 15: BI at admission of <5 (OR .08, CI .04-.17); National Institutes of Health stroke scale at admission of >7 (OR .23, CI .12-.43); urinary incontinence at admission (OR .35, CI .21-.60); age > or =65 years (OR .44, CI .25-.77); and abbreviated mental test at admission of <7 (OR .56, CI .33-.94).

CONCLUSIONS

For Chinese stroke patients, the disability at admission is the most important predictor for disability at discharge. Patients with very severe disability, severe neurologic impairment, urinary incontinence, old age, and impaired cognition at admission are less likely to recover to mild disability at discharge. Although hemorrhagic stroke is more common among Chinese populations, it is not an independent predictor for disability at discharge.

Using the comprehensive geriatric assessment technique to assess elderly patients

OBJECTIVE

To review the concept, components, and characteristics of the Comprehensive Geriatric Assessment technique.

DATA SOURCES

Medline and non-Medline literature search.

STUDY SELECTION

The following key words were used: Comprehensive Geriatric Assessment; all available years of study were reviewed.

DATA EXTRACTION

Studies that assessed the Comprehensive Geriatric Assessment technique's benefits were examined.

DATA SYNTHESIS

By using the Comprehensive Geriatric Assessment programme, accurate diagnoses can be made, treatable illness can be screened for, therapeutic plans can be formulated, and the optimal placements of patients can be achieved. Assessment should be performed at each level of geriatric care; various well-validated scales are used to measure the activity of daily living of patients. The Comprehensive Geriatric Assessment programme can improve functional status; reduce the use of medications, nursing homes, and medical services; and reduce mortality rates. Most studies confirm that a successful programme requires careful patient targeting, implementation of the programme by attending physicians, and patient adherence to the recommendations made.

CONCLUSION

A well-targeted Comprehensive Geriatric Assessment programme and the control of patients' adherence to recommendations are effective in improving the well-being of elderly patients.

Outcome after stroke rehabilitation in Hong Kong

OBJECTIVE

To determine the outcome of patients discharged to the community after stroke rehabilitation.

METHODS

One hundred and eighty-five consecutive patients discharged after stroke rehabilitation were enrolled for follow-up 12 months after discharge from a hospital in Hong Kong. A telephone interview to determine disability and place of residence was conducted. Disability was assessed by the Barthel Index and ratings of activities of daily living and mobility on a 4-point scale.

RESULTS

One hundred and thirty-one patients or their carers were contacted (70.1%). This comprised 19 patients (10.3%) who died and 112 patients or their carers (60.5%) who were interviewed. Fifty-four patients (29.2%) were lost to follow-up. Comparison of the patients contacted and those lost to follow-up did not detect membership bias. Median Barthel Index of the surviving patients who were contacted rose from 90.0 (interquartile range 78.75-100.0) at discharge to 100.0 (interquartile range 85.0-100.0) at 12 months. Ratings of activities of daily living and mobility were maintained, with significant improvement in toileting. After rehabilitation 77.3% of the patients were discharged home and there was no significant change in residence at 12 months. Elderly patients (> or = 70 years old) had higher rates of institutionalization after hospital discharge and more disability although they achieved similar gains in Barthel Index and had similar lengths of hospital stay compared to younger patients.

CONCLUSIONS

These results suggest that stroke patients were able to maintain their gains achieved during inpatient rehabilitation up to one year after discharge from hospital.

A geriatric day hospital in Hong Kong: an analysis of activities and costs

A survey of the activities of a geriatric day hospital in Hong Kong was carried out. It revealed that alternative modalities of hospital-based treatment were impractical and difficult to organize. Most patients and their carers were satisfied with the day hospital service, and the main area for improvement was in transportation. Costs of day hospital treatment were also calculated, and were found to be cheaper than an equivalent period of in-patient rehabilitation or out-patient therapy.

Outcomes of elderly stroke patients. Day hospital versus conventional medical management

BACKGROUND AND PURPOSE

Much controversy exists over the value of geriatric day hospitals in the rehabilitation of elderly patients, and cerebrovascular accident is a particularly common diagnosis among patients referred to these day hospitals. We carried out a prospective, randomized study to compare the outcomes of elderly stroke patients managed by a geriatric team using a day hospital facility versus conventional medical management.

METHODS

One hundred twenty elderly patients with acute stroke were randomized to inpatient care on a stroke ward under the care of either a neurologist or a geriatric team. Those under the care of neurologists were hospitalized until the attending physician felt that the patients had reached full rehabilitation potential. Patients under the care of the geriatric team were discharged home as soon as the team felt they were able to cope and given follow-up rehabilitation at the day hospital. Family or community support was arranged when necessary for both treatment groups. On recruitment, patient demographics, medical history, clinical features related to stroke, and functional ability as measured by the Barthel Index were noted. Subjects were reviewed at 3 and 6 months to assess functional level, hospital and outpatient services received, general well-being, mood, and level of satisfaction. Costs of treatment of the two groups were also compared.

RESULTS

Functional improvement (Barthel Index score) was greater in the group managed by the geriatricians with a day hospital facility compared with the conventional group at 3 months (P = .03). There were also fewer outpatient visits among the day hospital patients at 6 months (P = .03). No significant difference was found in costs between the two treatment groups.

CONCLUSIONS

Compared with conventional medical management, care in the geriatric day hospital hastened functional recovery and reduced outpatient visits in elderly stroke patients without additional cost.

Effect of age and disease on two drug binding proteins: albumin and alpha-1- acid glycoprotein

The influence of age and disease on serum albumin and alpha-1-acid glycoprotein was studied in 126 subjects (69 M, 57 F) presenting with tuberculosis and after recovery. Albumin concentration fell with age in both disease and healthy states, and alpha-1-acid glycoprotein concentration rose with age in the healthy state. Age-related differences were less marked in the disease state. During recovery from illness, serum albumin concentration rose and alpha-1-acid glycoprotein concentration fell. The mean concentration difference in the latter was lower in the older age groups. The clinical consequences of changes in binding protein concentrations as a result of ageing and disease need to be studied further for individual drugs.

A double-blind randomised comparison of perindopril and ketanserin in the treatment of hypertension in elderly diabetic patients

A double-blind, randomised study of the antihypertensive efficacy of perindopril and ketanserin in 44 elderly noninsulin-dependent diabetic patients aged > or = 60 years was conducted. Blood pressure, blood biochemical and haematological parameters, plasma vasoactive hormones, urinary volume, electrolytes and microalbumin were measured at baseline, after a 4-week placebo period, and at intervals during 8 weeks of treatment with active drug. Electrocardiogram and echocardiogram data were also obtained. Dosages of perindopril used were 2 mg once daily for 4 weeks doubling to 4 mg once daily if a target blood pressure of < or = 160/90 mm Hg was not reached. Dosages of ketanserin were 40 mg twice daily increasing to 80 mg twice daily. Both drugs caused a small but statistically insignificant reduction in blood pressure. Although the response rates (supine systolic blood pressure reduction of > 10 mm Hg) were 54% for perindopril and 45% for ketanserin, target blood pressure (supine blood pressure 160/90 mm Hg) was reached in only 21% of perindopril and 20% of ketanserin recipients. Plasma creatinine and 24-hour urine sodium excretion increased in patients receiving ketanserin therapy. Glycaemic indices and the lipid profile did not change in either group, except for a reduction in plasma triglycerides in the ketanserin group. No changes in urinary microalbumin, electrocardiogram, or echocardiographic cardiac parameters were observed. It is concluded that in the present study neither drug provoked a significant blood pressure lowering effect and that serum creatinine increased in the ketanserin group.

Treatment of severe orthostatic hypotension with the somatostatin analogue octreotide

The long-acting somatostatin analogue octreotide was used in a patient with severe orthostatic hypotension resistant to conventional treatment. 0.4 ug/kg octreotide given subcutaneously abolished the postural drop in systolic blood pressure for about four hours and was more effective than a combination of fludrocortisone and pindolol.