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Peer-based community interventions have shown promise in improving health management and fostering coping skills and psychosocial functioning among individuals with a disability. Active Rehabilitation camps are examples of peerbased community interventions that provide structured, time-limited peer mentorship in conjunction with sports and leisure activities. These camps hold potential benefits for individuals with acquired neurological injury. However, the specific impact of Active Rehabilitation camps on children or individuals with acquired brain injury remains unexplored. In this longitudinal, qualitative study, we explored children with an acquired brain injury and their caregivers' experiences with an Active Rehabilitation camp in Norway through observations and interviews with nine children and ten caregivers. Using an abductive thematic analysis, we identified an overarching theme: Active Rehabilitation peer mentorship camps enrich the lives of children with acquired brain injury and their caregivers. The theme contains three subthemes: (1) Interacting with peers made me wiser, (2) Nudging from peer mentors made me feel better, and (3) A sense of companionship through meeting peers. Peer mentorship, sports and leisure activities, and the safe camp atmosphere benefitted children with acquired brain injury and their caregivers. The children gained knowledge, motivation, and self-worth, and their caregivers had greater impetus to prioritize their children's independence. Meeting peers and peer mentors led to friendships and sustained social connections. The Self-Determination Theory was of assistance in explaining the informants' experiences. Active Rehabilitation camps provide children with acquired brain injury and their caregivers with an opportunity to develop better coping skills, improve psychological functioning, and build more robust social networks. [ABSTRACT FROM AUTHOR]

This observational cohort study explored objective neurocognitive deficits in COVID-19 patients five months after discharge, and any associations with demographic factors and disease severity indicators. Medical notes of all COVID-19 patients admitted to hospital in Region Östergötland, Sweden, March-May 2020, were reviewed. After applying exclusion criteria, 433 patients were screened by telephone. Of these, 185 patients reported persistent and concerning post-COVID-19 problems, including but not restricted to cognitive functions, and were invited to a clinical evaluation. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and Colour-Word Interference Test (CWIT) were used to assess immediate memory, visuo-spatial function, language, attention, delayed memory, and executive function. A total of 133 patients had valid test performances. Mean RBANS Global Cognition Score was 83.4, with 37% scoring below cut-off (1.5 SD). Deficits in Attention and Memory indices were most common, each affecting approximately 30% of the patients. After adjustment for sex, language, level of education and premorbid function, neurocognitive performance was positively associated with length of hospital stay, but not with the disease severity indicators WHO CPS and CRP. Findings support that comprehensive neuropsychological assessment should be performed when patients report post-COVID-19 symptoms that affect daily life. [ABSTRACT FROM AUTHOR]

Background: We investigated the personal philosophies of eight persons with a tetraplegic condition (four male, four female), all living in Sweden with a chronic spinal cord injury (SCI) and all reporting a good life. Our purpose was to discover if there is a philosophical mindset that may play a role in living a good life with a traumatic SCI. Methods: Two rounds of in‐depth qualitative interviews were performed by the same interviewer, a philosophical practitioner by training (de Miranda). The second round systematically covered the following elements: bodily sense, sense of self, sense of belonging, sense of the possible, sense of purpose and philosophical sense. This six‐step method developed by de Miranda is called SMILE_PH, an acronym for Sense‐Making Interviews Looking at Elements of Philosophical Health. Results: All the interviewees, as a consequence of their trauma, reported having gone through a reinvention of themselves which implied questioning the meaning and purpose of their life in particular and life in general. A philosophical rather than realistic sense of the possible was abstracted toward teleological growth. All interviewees developed a sense of purpose based on self‐interested altruism and solidarity with disabled peers. Conclusions: To reinvent a good life with SCI, in addition to physical training and willpower, one needs to consider philosophical questions about the self and life, what Kant called the cosmic interests of reason: What may I hope? What must I do? What can I know? Our results indicate that we should, in the future, explore what the philosophical health approach may bring to rehabilitation processes in the months or years that follow the trauma. [ABSTRACT FROM AUTHOR]

Background: Survival among critically ill COVID‐19 patients varies between countries and time periods. Mortality rates up to 60% have been reported in intensive care units (ICUs). Standard‐of‐care has evolved throughout the pandemic. The purpose of the study was to explore management and mortality of COVID‐19 ICU‐patients during the first pandemic wave and assess their post‐ICU health status. Methods: We conducted an exploratory observational ambidirectional population‐based study of ICU‐patients with COVID‐19 in a Swedish county during 1 March‐30 June 2020. Primary outcome was 60‐day mortality with secondary outcomes including treatments, complications, self‐reported general health and dyspnoea post‐discharge. Patients were consecutively divided into equal tertiles with cut‐offs on April 4 and April 20, 2020, to analyse time trends. Results: One hundred patients, median age was 63 years, were included, and 60‐day mortality rate was 22%. Ninety‐one percent had moderate/severe ARDS and 88% required mechanical ventilation. In the first tertile of patients 60‐day mortality was 33%, declining to 15% and 18% in the following two. This reduction paralleled increased use of thromboprophylaxis, less steep rise of treated ICU‐patients per day and expanded ICU resources. Four months post‐discharge, 63% of survivors reported self‐assessed decline in general health retrospectively compared to prior COVID‐19. Conclusions: In this cohort, the initial 60‐day mortality quickly declined, despite continuous admittance of critically ill patients. This was parallel to adaptation to increased workload and more intense thromboembolic prophylaxis. A majority of survivors reported declined general health four months after discharge. Further studies on long‐term health status of ICU‐survivors are indicated. [ABSTRACT FROM AUTHOR]

Background: Nonspecific low back pain (LBP) can progress to chronic disability and prolonged absence from work. Despite clinical and professional guidelines, physiotherapists often fail to address return to work outcomes. Aims: The aim of this exploratory study was to determine whether an e-learning resource tailored to physiotherapy practice could affect physiotherapists' attitudes and beliefs regarding return to work advice for their patients. Design: A prospective interventional cohort study (pilot). Methods: Participants were recruited via the Chartered Society of Physiotherapy website. Responses on a clinical vignette, the Health Care Providers' Pain and Impairment Scale (HC-Pairs), and the Behavioral Constructs Questionnaire (BCQ) were collected online at baseline (Q1) and 2-months post-intervention (Q2). Results: Fifty-four physiotherapists completed Q1 and the response rate for Q2 was 44/54 (81%). Changes in the degree of agreement with guidelines indicated that the intervention made an impact on respondents (kappa 0.345; p = 0.003). HC-Pairs and BCQ results showed a nonstatistically significant trend toward the target behavior. Conclusions: There is a need for interventions to improve adherence with advice for return to work following nonspecific LBP. An e-learning tool for physiotherapists on advising patients regarding return to work has potential to positively affect self-reported clinical behavior. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether attending a face-to-face pre-operative joint replacement education in a regional setting reduces overall hospital costs and length of stay (LOS) following total knee replacement (TKR) or total hip replacement (THR). Methods: A retrospective clinical audit reviewed the medical records of all patients who underwent an elective THR or TKR at Rockhampton Hospital in regional Queensland, Australia, between 03/2015 and 12/2016 (22 months). The pre-operative joint replacement education class was provided by a multidisciplinary team that included a physiotherapist, an occupational therapist, a dietician, a pharmacist and a social worker. In addition to demographic data, we extracted and analysed data related to total acute care and total healthcare cost, prevalence of post-operative complications, discharge destination and comorbidities (using the Functional Comorbidity Index). Results: Out of 326 cases that were included in the analysis, 115 cases with TKR and 51 cases with THR attended a pre-operative education class. Demographic characteristics between those attending and not attending the class were largely similar, except from more females attending in the THR group. There was no difference in hospital costs or LOS between those who attended the class compared to those who did not for both the TKR and THR groups. Outcomes related to total acute stay costs, total cost including travel and education and score for Functional Comorbidities Index were similar between those who attended the class and those who did not. Conclusion: Pre-operative education does not reduce hospital costs (surgery and hospital stay) in Central Queensland. [ABSTRACT FROM AUTHOR]

Background: Active Rehabilitation (AR) is a community peer-based concept for people with spinal cord injury (SCI) that is primarily delivered through brief residential training programmes. Despite a plethora of positive anecdotal evidence of AR programmes as life-changing experiences, the effects of AR-programmes have not been evaluated scientifically. Here, we present the protocol of the INTERnational Project for the Evaluation of "activE Rehabilitation" (inter-PEER) aiming to evaluate the effects of AR training programmes on community-dwelling individuals with SCI.Methods: International prospective cohort study that recruits consecutive participants in AR training programmes. Evaluation is conducted through a web-based survey at 3 time-points: at the commencement and completion of the training programme, and 3 months after the end of the training programme. Evaluation also includes a practical wheelchair skills test at the first two time-points. The primary outcome measures are the Spinal Cord Independence Measure Self-report (SCIM-SR), the Queensland Evaluation of Wheelchair Skills test (QEWS), the Wheelchair Skills Test Questionnaire (WST-Q) and the Moorong Self-Efficacy Scale (MSES). The secondary outcome measures are the 11-item Life Satisfaction Questionnaire (LiSat-11), the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation), the Leisure Time Physical Activity Questionnaire for people with SCI (LTPAQ-SCI) and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). We piloted the implementation of the protocol in Sweden in 7 participants with diverse SCI and sociodemographic characteristics and collected feedback from participants and peer-mentors about study procedures through interviews, a workshop and field observations.Discussion: Inter-PEER is the first initiative to propose a systematic evaluation of the effects of AR training programmes among individuals with SCI. The project is a collaborative work of multiple stakeholders, including researchers, clinicians, peer mentors with SCI, and administrators of organisations providing AR programmes. The inter-PEER uses standardised outcome measures relevant to the AR context, it will facilitate quality evaluations of community peer-based programmes, stimulate international collaborations, and inform the design of randomised controlled trials on the effects of AR training programmes. [ABSTRACT FROM AUTHOR]

Introduction Ventilator-associated pneumonia (VAP) is a medical complication associated with prolonged mechanical ventilation. Most studies looking at VAP originate from major, tertiary intensive care units (ICUs). Our understanding of VAP in regional hospitals is limited. Given that patient characteristics often differ between metropolitan and regional centres, it is important to investigate VAP in a regional non-tertiary ICU. This project will establish and report the incidence, case characteristics and outcomes including mortality and length of stay related to VAP in a regional non-tertiary Australian ICU. Furthermore, it will compare the incidence of VAP in accordance with consultant diagnosed cases in the medical record, and by a post hoc screening of all cases against a list of previously published diagnostic criteria. Methods and analysis This retrospective clinical audit study will screen medical records from the period 1 January 2013 to 31 December 2016. All cases requiring mechanical ventilation for ≥72 hours will be screened against previously reported diagnostic criteria for VAP. At the same time, their medical records will be screened for a documented diagnosis of VAP. Ethics and dissemination This study has been granted ethical approval from the Central Queensland Hospital and Health Service (CQHHS) Human Research Ethics Committee (HREC/17/QCQ/11) and the Central Queensland University Human Research Ethics Committee (H17/05-102). This study will be submitted for publication in a peer-reviewed scientific journal and presented at internal workshops (within Queensland Health) and national and/or international scientific conferences. [ABSTRACT FROM AUTHOR]

Study design:Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).Objectives:To evaluate and compare outcomes, length of stay (LOS), associated conditions and medical complications at 1-year post-trauma.Settings:The Greater Thessaloniki region, Greece, and the Greater Stockholm region, Sweden. While Stockholm follows a SCI system of care, Thessaloniki follows a fragmented ‘non-system’ approach.Subjects:Out of the 87 cases in Thessaloniki and the 49 cases in Stockholm who comprised the study population of STATSCIS, 75 and 42 cases respectively were successfully followed-up during the first year post-trauma.Results:Significantly superior outcomes (that is, survival with neurological recovery, functional ability and discharge to home) and shorter LOS for initially motor complete cases occurred in Stockholm. Management routines known to increase long-term morbidity, for example, long-term tracheostomy and indwelling urethral catheters were significantly more common in Thessaloniki. Major medical complications, that is, multiple pressure ulcers, heterotopic ossification and bacteremia/sepsis were more frequent in Thessaloniki.Conclusions:Our findings show how two rather similar cohorts of TSCI manifest large discrepancies in terms of 1-year outcomes and complications, depending on the type of management they receive. As the major difference between regions was the presence or absence of a SCI system of care, rather than differences in availability of modern medicine, the mere presence of the latter does not seem to be sufficient to guarantee adequate outcomes. This study provides strong evidence as to the urgent need of implementing a SCI system of care in Greece. [ABSTRACT FROM AUTHOR]

Study design:Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).Objectives:To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI).Settings:The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden.Methods:Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry.Results:There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki.Conclusions:Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not. [ABSTRACT FROM AUTHOR]

Study design:Prospective population-based open-ended study. This paper is part of the Stockholm–Thessaloniki Acute Traumatic Spinal Cord Injury Study.Objectives:To calculate incidence and evaluate the epidemiological profile of the incident population with traumatic spinal cord injury (TSCI).Settings:The greater Thessaloniki region in Greece and the greater Stockholm region in Sweden.Methods:TSCI individuals, older than 15 years of age, who had survived the first 7 days post-trauma, were identified through an active surveillance system. The forms of the Nordic Spinal Cord Injury Registry were used.Results:87 individuals were injured in the greater Thessaloniki and 49 in the greater Stockholm region. Annual crude incidence was 33.6 per million for Thessaloniki and 19.5 per million for the Stockholm region. The leading causes of injury for the Thessaloniki region were transportation accidents (51%) and falls (37%), and those for the Stockholm region were falls (47%) and transportation accidents (23%). A significantly larger number of individuals of the Thessaloniki group were injured in transportation accidents. There was no significant difference between regions with regard to the type of resulting impairment.Conclusions:Incidence of TSCI was considerably higher in the Thessaloniki region as compared with that in the Stockholm region, probably chiefly reflecting differences in preventative measures with regard to driving. [ABSTRACT FROM AUTHOR]

We used Lamotrigine LTG (50-600mg /24h) in 12 patients, 58-to 95-years-old (A Group) and other antiepileptics in nine patients (B Group) with the diagnosis of probable Alzheimer's disease (AD) and seizures. We also administered LTG (50-700mg/24h) in 16 patients (C Group) and other antiepileptics in nine patients (D Group) with other neurological disorders with cognitive disorders and seizures. The results showed that in eight from 12 patients with AD, and in nine from 16 with other neurological disorders, seizures stopped after treatment with LTG—while in five from nine patients with AD and six from 18 with other neurological disorders, seizures stopped after treatment with other antiepileptic drugs. Side effects in 28 patients treated with LTG included only three mild rashes, while side effects in 18 patients treated with other antiepileptic drugs included—six patients with fatigue, two with rashes, one with dizziness, one with low platelets, one with sleepiness and one with loss of hair. Conclusively, this study shows that LTG is an effective and safe monotherapy in patients with cognitive disorders and AD. [ABSTRACT FROM PUBLISHER]

A conference paper on the neurophysiological effects of anticonvulsant oxcarbazepine on corticomotor excitability with plasma levels of the parent drug and metabolites is presented. Around 20 patients with partial epilepsy and 10 patients with neuropathic pain were studied before and after the administration of oxcarbazepine. Results reveal that oxcarbazepine increases corticomotor threshold and this neurophysiological effect is mediated primarily by 10-hydroxy-10, 11-dihydrocarbamazepine.