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Background: Recent reports show substantial geographic variation in postacute health care spending. Little is known about variation in functional outcomes after postacute rehabilitation for patients with hip fracture. We examined variation in mobility and self-care after hip fracture rehabilitation across inpatient rehabilitation facilities (IRFs), hospital referral regions (HRRs) and states.Methods: Retrospective cohort study using data from the Centers for Medicare and Medicaid Services (CMS) from 2006 to 2009. Study sample included 149,258 records from patients 66 years and older at 1,166 IRFs located within 292 HRRs and across 50 states. Hip fracture cases were defined by CMS impairment group codes (08.11, 08.12). Hierarchical generalized linear models were used to assess discharge mobility and self-care functional status, adjusting for individual patient characteristics and the random effect of IRFs, HRRs, and states.Results: Variation in discharge mobility status as assessed by the intraclass correlation percentage (ICC%) was 8.8% across IRFs, 4.0% across HRRs, and 1.8% across states. For self-care, the ICCs were 10.2% across IRFs, 4.8% across HRRs, and 2.4% across states. The range of discharge mobility scores (maximum functional status rating to minimum functional status rating) showed a 9.6-point difference for IRFs, 6.5 for regions, and 2.6 for states. Range of discharge self-care scores were 13.1 for IRFs, 6.8 for HRRs, and 3.4 for states.Conclusion: Variation in functional status following postacute hip fracture rehabilitation appears to occur primarily at the level of facilities rather than geographic location. [ABSTRACT FROM AUTHOR]

This article highlights the need for governing some gradual ruptures from the past to achieve a sense of new normalcy in public health. The rebel returnees during the pandemic form a case of a vulnerable group who triply experience disasters: from the pandemic and natural disasters to terrorism. Global health governance carries on the management of past problems attaining their maturation and faces new ones for disaster recovery. [ABSTRACT FROM AUTHOR]

The article discusses covid-19 recovery plan leading to herd immunity in Philippines referencing two previous correspondence by Gozum. Topics discussed include lack of long-term strategic recovery plan by Phillippines's government to achieve herd immunity in the Philippines; lack of access of Western-made vaccines throughout the country; and failure of Inter-Agency Task Force for the Management of Emerging Infectious Diseases in submitting indemnity agreement to COVAXIN.

The article discusses the narratives of people recovering from heart surgery and the dominant theme of "restitution" narratives in their stories, with reference to Arthur Frank's work on illness narratives.

The article discusses the design and development of a web-based resource called REPARERE, which aims to support patients and their families in recovering from Coronary Artery Bypass Grafting (CABG) surgery.

Aims: There is lack of conclusive evidence from randomized clinical trials on the efficacy and safety of upgrade to cardiac resynchronization therapy (CRT) in patients with implanted pacemakers (PM) or defibrillators (ICD) with reduced left ventricular ejection fraction (LVEF) and chronic heart failure (HF). The BUDAPEST-CRT Upgrade Study was designed to compare the efficacy and safety of CRT upgrade from conventional PM or ICD therapy in patients with intermittent or permanent right ventricular (RV) septal/apical pacing, reduced LVEF, and symptomatic HF.Methods and Results: The BUDAPEST-CRT study is a prospective, randomized, multicentre, investigator-sponsored clinical trial. A total of 360 subjects will be enrolled with LVEF ≤ 35%, NYHA functional classes II-IVa, paced QRS ≥ 150 ms, and a RV pacing ≥ 20%. Patients will be followed for 12 months. Randomization is performed in a 3:2 ratio (CRT-D vs. ICD). The primary composite endpoint is all-cause mortality, a first HF event, or less than 15% reduction in left ventricular (LV) end-systolic volume at 12 months. Secondary endpoints are all-cause mortality, all-cause mortality or HF event, and LV volume reduction at 12 months. Tertiary endpoints include changes in quality of life, NYHA functional class, 6 min walk test, natriuretic peptides, and safety outcomes.Conclusion: The results of our prospective, randomized, multicentre clinical trial will provide important information on the role of cardiac resynchronization therapy with defibrillator (CRT-D) upgrade in patients with symptomatic HF, reduced LVEF, and wide-paced QRS with intermittent or permanent RV pacing.Clinical Trials.gov Identifier: NCT02270840. [ABSTRACT FROM AUTHOR]

Recent advances in functional neuroimaging have demonstrated novel potential for informing diagnosis and prognosis in the unresponsive wakeful syndrome and minimally conscious states. However, these technologies come with considerable expense and difficulty, limiting the possibility of wider clinical application in patients. Here, we show that high density electroencephalography, collected from 104 patients measured at rest, can provide valuable information about brain connectivity that correlates with behaviour and functional neuroimaging. Using graph theory, we visualize and quantify spectral connectivity estimated from electroencephalography as a dense brain network. Our findings demonstrate that key quantitative metrics of these networks correlate with the continuum of behavioural recovery in patients, ranging from those diagnosed as unresponsive, through those who have emerged from minimally conscious, to the fully conscious locked-in syndrome. In particular, a network metric indexing the presence of densely interconnected central hubs of connectivity discriminated behavioural consciousness with accuracy comparable to that achieved by expert assessment with positron emission tomography. We also show that this metric correlates strongly with brain metabolism. Further, with classification analysis, we predict the behavioural diagnosis, brain metabolism and 1-year clinical outcome of individual patients. Finally, we demonstrate that assessments of brain networks show robust connectivity in patients diagnosed as unresponsive by clinical consensus, but later rediagnosed as minimally conscious with the Coma Recovery Scale-Revised. Classification analysis of their brain network identified each of these misdiagnosed patients as minimally conscious, corroborating their behavioural diagnoses. If deployed at the bedside in the clinical context, such network measurements could complement systematic behavioural assessment and help reduce the high misdiagnosis rate reported in these patients. These metrics could also identify patients in whom further assessment is warranted using neuroimaging or conventional clinical evaluation. Finally, by providing objective characterization of states of consciousness, repeated assessments of network metrics could help track individual patients longitudinally, and also assess their neural responses to therapeutic and pharmacological interventions. [ABSTRACT FROM AUTHOR]

Aims: Radiofrequency (RF) catheter ablation (CA) is superior to standard medical therapy in controlling recurrent ventricular tachycardia (VT). The majority of procedures have been performed in a middle-aged population. The outcome of VT ablation in the elderly has not been described.Methods and Results: We retrospectively studied the outcome and safety of CA of VT in octogenarians performed in four European centres. The population consisted of patients presenting with recurrent VT refractory to medical therapy. Patients aged over 80 years were compared with younger patients undergoing CA. Clinical characteristics, procedural data, complications, and outcomes were examined. Implantable cardioverter-defibrillator (ICD) therapy data were collected. A total of 54 consecutive octogenarian patients underwent RF CA of VT and represented the study group (42 males, age 82.8 ± 2.7 years) compared with a control group of 104 younger patients (85 males, age 66.7 ± 8.9 years). Mean follow-up was 33 ± 48 months. Implantable cardioverter-defibrillators were present in 81 and 86% of patients, respectively (P = 0.93). Left ventricular ejection fraction was 29% ± 8.2 in octogenarians vs. 34% ± 10.2 in the younger group (P < 0.01). More major complications occurred in octogenarians (18 vs. 2%, P < 0.01). During follow-up, there were more ICD shocks in the octogenarians (28 vs. 15%, P < 0.01). The Kaplan-Meier curve of survival after VT ablation confirms comparable survival rates at 1 year, but the elderly have poor survival in the mid-term. Survival in the elderly post VT ablation is comparable with that in an age-matched cohort with ICDs but no VT storm.Conclusion: Octogenarians undergoing CA of VT have more risk factors, higher risk of complications and ICD shocks, but demonstrate comparable short-term survival rates. [ABSTRACT FROM AUTHOR]

Introduction: This case study describes the application of a commercially available, custom myoelectric elbow-wrist-hand orthosis (MEWHO), on a veteran diagnosed with chronic stroke with residual left hemiparesis. The MEWHO provides powered active assistance for elbow flexion/extension and 3 jaw chuck grip. It is a noninvasive orthosis that is driven by the user's electromyographic signal. Experience with the MEWHO and associated outcomes are reported.Materials and Methods: The participant completed 21 outpatient occupational therapy sessions that incorporated the use of a custom MEWHO without grasp capability into traditional occupational therapy interventions. He then upgraded to an advanced version of that MEWHO that incorporated grasp capability and completed an additional 14 sessions. Range of motion, strength, spasticity (Modified Ashworth Scale [MAS]), the Box and Blocks test, the Fugl-Meyer assessment and observation of functional tasks were used to track progress. The participant also completed a home log and a manufacturers' survey to track usage and user satisfaction over a 6-month period.Results: Active left upper extremity range of motion and strength increased significantly (both with and without the MEWHO) and tone decreased, demonstrating both a training and an assistive effect. The participant also demonstrated an improved ability to incorporate his affected extremity (with the MEWHO) into a wide variety of bilateral, gross motor activities of daily living such as carrying a laundry basket, lifting heavy objects (e.g. a chair), using a tape measure, meal preparation, and opening doors.Conclusion: Custom myoelectric orthoses offer an exciting opportunity for individuals diagnosed with a variety of neurological conditions to make advancements toward their recovery and independence, and warrant further research into their training effects as well as their use as assistive devices. [ABSTRACT FROM AUTHOR]

We hypothesized that the recovery of speech production after left hemisphere stroke not only depends on the integrity of language-specialized brain systems, but also on 'domain-general' brain systems that have much broader functional roles. The presupplementary motor area/dorsal anterior cingulate forms part of the cingular-opercular network, which has a broad role in cognition and learning. Consequently, we have previously suggested that variability in the recovery of speech production after aphasic stroke may relate in part to differences in patients' abilities to engage this domain-general brain region. To test our hypothesis, 27 patients (aged 59 ± 11 years) with a left hemisphere stroke performed behavioural assessments and event-related functional magnetic resonance imaging tasks at two time points; first in the early phase (∼2 weeks) and then ∼4 months after the ictus. The functional magnetic resonance imaging tasks were designed to differentiate between activation related to language production (sentential overt speech production-Speech task) and activation related to cognitive processing (non-verbal decision making). Simple rest and counting conditions were also included in the design. Task-evoked regional brain activations during the early and late phases were compared with a longitudinal measure of recovery of language production. In accordance with a role in cognitive processing, substantial activity was observed within the presupplementary motor area/dorsal anterior cingulate during the decision-making task. Critically, the level of activation within this region during speech production correlated positively with the longitudinal recovery of speech production across the two time points (as measured by the in-scanner performance in the Speech task). This relationship was observed for activation in both the early phase (r = 0.363, P = 0.03 one-tailed) and the late phase (r = 0.538, P = 0.004). Furthermore, presupplementary motor area/dorsal anterior cingulate activity was a predictor of both language recovery over time and language outcome at ∼4 months, over and above that predicted by lesion volume, age and the initial language impairment (general linear model overall significant at P < 0.0001; ExpB 1.01, P = 0.02). The particularly prominent relationship of the presupplementary motor area/dorsal anterior cingulate region with recovery of language was confirmed in voxel-wise correlation analysis, conducted unconstrained for the whole brain volume. These results accord with the hypothesis that the functionality of the presupplementary motor area/dorsal anterior cingulate contributes to language recovery after stroke. Given that this brain region is often spared in aphasic stroke, we propose that it is a sensible target for future research into rehabilitative treatments. More broadly, baseline assessment of domain-general systems could help provide a better prediction of language recovery. [ABSTRACT FROM AUTHOR]

This paper examines recovery from intimate partner violence and mental health problems through the perspective of experiential expertise (EE). The aim is to investigate the formation of EE in the context of empowerment-oriented recovery in non-governmental organisations (NGOs). This triangulated study includes both quantitative and qualitative data. The quantitative part was acquired through a survey on people with personal experience of mental health problems (N = 133) and the qualitative part was collected from a development project including sixty female victims of intimate partner violence and nine professionals who worked with the women. First, the data were analysed separately through statistical analysis and hermeneutic close reading. Second, a triangulated synthesis was made. There are three types of EE: individual, group and organised. These provide a basis for personal and social empowerment. EE consists of emotional and influential ways of acting, which enable renewed action as well as the reformation of a self-image. Our findings indicate that the relation between EE and recovery is reciprocal and mutually beneficial. We argue that especially group and organised EE should be integrated more firmly into social work practices, preventive social policy and structural social work. [ABSTRACT FROM AUTHOR]

Despite intense focus on child sexual exploitation (CSE) in the UK, little is known about how and why some young people recover well from sustained exploitation by multiple perpetrators. Using thematic analysis, three published memoirs by young people (female) about their sexual exploitation by groups of men in the UK are analysed for insight into what contributes to positive short- and long-term outcomes. Despite the populist nature of the publications, the memoirs offer an important insight into young people's understandings of their exploitation. The rich detail inherent to memoir exposes the complexities and dilemmas faced by the young people and the professionals involved. Being listened and believed by family and professionals is the most significant aspect to positive adaptation post exploitation in these accounts. However, the dynamics of grooming and the nature of contemporary social work intervention and investigation render disclosure difficult. As these accounts illustrate, CSE is characterised by uncertainty and complexity, and this is the domain in which social work needs to intervene more successfully to support young people. [ABSTRACT FROM AUTHOR]

Concurrent injuries to multiple extremities present unique challenges to the reconstructive surgeon. The primary goal in such scenarios is to optimize functional outcomes. The goal of this article is to present an overview of various techniques necessary to provide sufficient soft tissue and preserve amputation limb lengths and function. The concept of innovative techniques for maximizing limb savage and function is presented using an index patient with multiple extremity third- and fourth-degree burn injuries resulting in nonsalvageable lower extremities and severe left-hand wounds. A review of other potential innovative techniques is discussed. The burn injury resulted in a need for bilateral guillotine below-knee amputations. Above-knee amputation was avoided in the left leg using a parascapular free fasciocutaneous flap, while through-knee amputation was preferred to above-knee amputation in the right leg. The preservation of areas with questionable viability resulted in salvaging the left hand of the patient using digital palmar flaps to resurface the dorsum with creation of a first web-space. Maintenance of maximal viable length of limbs and any residual function in the limbs can be of significant functional benefit to multiple limb amputation patients. Maximizing the limb length in such patients is critical, and typical "rules" that have traditionally been utilized to minimize numbers of operations and optimize prosthetic fit may not apply. [ABSTRACT FROM AUTHOR]

Major advances in functional recovery following burn injury over the last ten years include the development of conceptual framework for disability assessment and its application burn recovery, the description of the long-term outcomes in the burn population, and progress in basic science research leading to new treatments that improve long-term functional outcomes. Future tasks and challenges include the development of common data elements and standards for burn recovery in order to measure and optimize the path toward functional recovery. The development of patient-reported outcome measures with benchmarks for recovery over time has the potential to improve patient-provider communication and quality of patient-centered care. The study of burn recovery should include an examination of resiliency along with the study of disabilities following burn injury. Better understanding of the mechanisms, impact and modulation of hypermetabolism and inflammation following burn injury is essential to improve functional recovery. Continued basic science and clinical research must focus on scar modulation and skin replacements and address recalcitriant problems such as heterotopic ossification. Health tracking technologies should be leveraged to understand and optimize physical therapy interventions. [ABSTRACT FROM AUTHOR]

Short-chain fatty acids (SCFAs), mainly acetate, propionate and butyrate, produced by microbial fermentation of undigested food substances are believed to play a beneficial role in human gut health. Short-chain fatty acids influence colonic health through various mechanisms. In vitro and ex vivo studies show that SCFAs have anti-inflammatory and anticarcinogenic effects, play an important role in maintaining metabolic homeostasis in colonocytes and protect colonocytes from external harm. Animal studies have found substantial positive effects of SCFAs or dietary fiber on colonic disease, but convincing evidence in humans is lacking. Most human intervention trials have been conducted in the context of inflammatory bowel disease. Only a limited number of those trials are of high quality, showing little or no favorable effect of SCFA treatment over placebo. Opportunities for future research include exploring the use of combination therapies with anti-inflammatory drugs, prebiotics or probiotics; the use of prodrugs in the setting of carcinogenesis; or the direct application of SCFAs to improve mucosal healing after colonic surgery. [ABSTRACT FROM AUTHOR]

Self-help and peer-provided services for mental health and addictions have grown rapidly in recent years. Many individuals who seek professional social work services are also involved in peer-provided recovery activities. Although many social workers have positive relationships with peer-provided organizations in their communities, there is a need for social workers to increase their understanding of the goals and principles of peer-provided services, so that collaborative relationships can be established. This article provides an overview of several kinds of self-help and peer-provided services, detailing the ways in which these services can be helpful and outlining how social workers can work more closely in partnership with peer providers. [ABSTRACT FROM AUTHOR]

Despite increasing evidence of the impact of health inequalities on mental health (Pickett and Wilkinson, 2015), there is only limited recognition of the potential role for mental health social work in addressing 'upstream' as well as 'downstream' challenges of poverty, disadvantage and oppression affecting many people experiencing mental health difficulties. This paper presents some of the current evidence concerning mental health inequalities and the opportunities for mental health social workers to promote well-being. A theme throughout the paper is the need to avoid the many examples of dichotomous thinking that frequently characterise thinking about mental health and mental health practice. Additionally, the limitations of an individualised recovery discourse are acknowledged. Drawing on Krieger's (2011) eco-social model, the social determinants of mental health are considered and the concept of embodiment is examined for its contribution to a more nuanced understanding of the relationship between inequality and health. Finally, the paper offers a version of mental health social work that 'faces both ways', involving issues at both the individual and the wider societal levels. This includes developing and extending partnerships with service users and carers and with other professional and agencies. [ABSTRACT FROM AUTHOR]

Although much research has been done on repetitive transcranial magnetic stimulation (rTMS) in chronic stroke, only sparse research has been done in acute stroke despite the particularly rich potential for neuroplasticity in this stage. We attempted a preliminary clinical trial in one active, high-quality inpatient rehabilitation facility (IRF) in the United States. But after enrolling only 4 patients in the grant period, the study was stopped because of low enrollment. The purpose of this paper is to offer a perspective describing the important physiologic rationale for including rTMS in the early phase of stroke, the reasons for our poor patient enrollment in our attempted study, and recommendations to help future studies succeed. We conclude that, if scientists and clinicians hope to enhance stroke outcomes, more attention must be directed to leveraging conventional rehabilitation with neuromodulation in the acute phase of stroke when the capacity for neuroplasticity is optimal. Difficulties with patient enrollment must be addressed by reassessing traditional inclusion and exclusion criteria. Factors that shorten patients' length of stay in the IRF must also be reassessed at all policy-making levels to make ethical decisions that promote higher functional outcomes while retaining cost consciousness. [ABSTRACT FROM AUTHOR]

Cutaneous functional units (CFUs) are fields of skin that functionally contribute to range of motion (ROM) at an associated joint. When replaced with scar tissue, the skin is less extensible and may result in loss of movement at the joint. Consideration of the amount of CFU affected by burn injury is increasingly being used to predict the development of burn scar contracture (BSC) in burn survivors. Previous work established that, in adults, burn rehabilitation time per CFU was the greatest predictor of preventing BSC. Our study aimed to examine the direct relationship between percent involvement of CFU and ROM achieved in children with BSC who received 6 months of rehabilitation therapy services. ROM was measured at baseline and throughout the study period using traditional methods of goniometry as well as three-dimensional motion capture during the performance of functional tasks. Burn extent and distribution were mapped using an electronic diagram to calculate the percentage of CFU affected by scarring or skin grafts. Pearson's correlations and multivariate linear regression analyses were performed to determine associations between variables. Results showed that percent CFU involvement was negatively correlated with maximal goniometric and functional shoulder ROM achieved. That is, the amount of a given CFU scarred was predictive of less ROM achieved in the associated area. Percentage of CFU involved did not significantly correlate with baseline shoulder ROM, suggesting that other factors may be associated with initial limitations in ROM. Evaluation of the percentage of CFU scarred is useful for predicting shoulder ROM recovery with rehabilitation and may be used to help guide clinical decision making and allocation of time and resource for therapy services. [ABSTRACT FROM AUTHOR]

Aims: Atrioventricular junction (AVJ) ablation followed by biventricular pacing is an established strategy for improving symptoms and morbidity in patients with permanent atrial fibrillation (AF), reduced left ventricular ejection fraction (LVEF), and uncontrolled ventricular rate. There is no clear evidence that such patients benefit from rate-responsive (RR) pacing.Methods and Results: This prospective, randomized, single-blind, multicentre study was designed as an intra-patient comparison and enrolled 60 patients (age 69.5 ± 11.8 years, males 63.3%, NYHA 3.0 ± 0.6) with refractory AF and reduced LVEF (mean 32.4 ± 8.3%) treated with AVJ ablation and biventricular pacing. Two 6-minute walking tests (6MWT) were performed 1 week apart: one during VVI 70/min biventricular pacing and the other during VVIR 70-130/min biventricular pacing; patients were randomly and blindly assigned to Group A (n = 29, first 6MWT in VVIR mode) or B (n = 31, first 6MWT in VVI mode). Rate-responsive activation determined an increase of 18.8 ± 24.4 m in the distance walked during the 6MWT (P < 0.001). The increase was similar in both groups (P = 0.571). A >5% increase in the distance walked was observed in 76.7% of patients. The increase in the distance walked was linearly correlated with the increase in heart rate recorded during the 6MWT in the VVIR mode (r = 0.54; P < 0.001).Conclusion: In permanent AF patients with uncontrolled rate and reduced LVEF who had undergone AVJ ablation and biventricular pacing, RR pacing yields a significant gain in exercise capacity, which seems to be related to the RR-induced frequency during effort. [ABSTRACT FROM AUTHOR]

Background: Many patients experience the 'cardiac blues' at the time of an acute cardiac event, and one in five go on to develop severe depression. These emotional responses often go undetected and unacknowledged. We initiated the 'Cardiac Blues Project' in order to help support patients' emotional recovery. As part of the project, we developed online training in order to support health professionals in the identification and management of the cardiac blues and depression. The aim of this study was to assess the acceptability of the training and its impacts on health professionals' self-efficacy. Method: In July 2014, a 'cardiac blues' pack of patient resources, including access to health professional online training, was mailed to 606 centres across Australia. In the first 3 months after distribution, 140 health professionals registered to undertake the online training and participated in the present study. Participants provided information via a six-item pre- and post-training self-efficacy scale and on 10 post-training acceptability items. Results: Health professionals' self-efficacy improved significantly after undertaking the online training across the six domains assessed and for the total score. Acceptability of the training was high across all 10 items assessed. Ratings of usefulness of the training in clinical practice were particularly favourable amongst those who worked directly with cardiac patients. Conclusions: The health professional training significantly improves health professionals' confidence in identifying and managing the 'cardiac blues' and depression. Monitoring of uptake is ongoing and future studies will investigate patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital.Design: Retrospective cohort study.Setting: One acute and one rehabilitation hospital in Japan.Participants: Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years).Main Outcome Measures: Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital.Results: Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5).Conclusions: The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care. [ABSTRACT FROM AUTHOR]

Background: the implications of partial and no recovery from delirium after hospital discharge are not clear. We sought to explore whether partial and no recovery from delirium among recently discharged patients predicted increased adverse events (emergency room visits, hospitalisations, death) during the subsequent 3 months. Method: prospective study of recovery from delirium in older hospital inpatients. The Confusion Assessment Method was used to diagnose delirium in hospital and determine recovery status after discharge (T0). Adverse events were determined during the 3 months T0. Survival analysis to the first adverse event and counting process modelling for one or more adverse events were used to examine associations between recovery status (ordinal variable, 0, 1 or 2 for full, partial or no recovery, respectively) and adverse events. Results: of 278 hospital inpatients with delirium, 172 were discharged before the assessment of recovery status (T0). Delirium recovery status at T0 was determined for 152: 25 had full recovery, 32 had partial recovery and 95 had no recovery. Forty-four patients had at least one adverse event during the subsequent 3 months. In multivariable analysis of one or more adverse events, poorer recovery status predicted increased adverse events; the hazard ratio (HR) (95% confidence interval, CI) was 1.72 (1.09, 2.71). The association of recovery status with adverse events was stronger among patients without dementia. Conclusion: partial and no recovery from delirium after hospital discharge appear to predict increased adverse events during the subsequent 3 months These findings have potentially important implications for in-hospital and post-discharge management and policy. [ABSTRACT FROM AUTHOR]

Background. Health care providers need prognostic factors to distinguish between patients who are likely to recover and those who are not likely to recover. Objective. The aim of this study was to: (1) describe the clinical course of recovery and (2) identify prognostic factors of recovery in patients with shoulder pain at the 26-week follow-up. Design. A prospective cohort study was carried out in the Netherlands and included 389 patients who consulted a physical therapist for a new episode of shoulder pain. Method. Participants were followed for 26 weeks. Potential predictors of recovery were selected from the literature and, with the addition of 2 new variables (ie, use of diagnostic ultrasound and working alliance), evaluated in the multivariable regression analysis. Multiple imputation was used to handle missing data, and bootstrap methods were used for internal validation. Results. The recovery rate was 60% for the total population and 65% for the working population after 26 weeks. Short duration of complaints, lower disability scores, having a paid job, better working alliance, and no feelings of anxiety or depression were associated with recovery. In the working population, only duration of complaints and disability remained in the final model. The area under the receiver operating characteristic curve (AUC) for the final model was 0.67 for the total population and 0.63 for the working population. After internal validation, the AUC was corrected to 0.66 and 0.63, respectively. Limitations. External validation of the prognostic model should be done prior to its use in clinical practice. Conclusion. The results of this study indicate that several factors can predict recovery. [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment is common in the hip fracture patient population, yet few studies of functional recovery include this subgroup. The objective was to determine whether baseline cognition was a determinant of the rate of functional recovery over 6 months after hip fracture.Methods: A consecutive cohort of 383 patients 65 years or older who were treated for hip fracture within a Canadian health region were grouped on cognitive status. Participants with Mini-Mental Status Examination scores <18 at 3-5 days postoperatively were classified as cognitively impaired. Primary outcome was the Functional Independence Measure. Interviews were completed within 5 days postoperatively (baseline), 1, 3, and 6 months postoperatively. Linear mixed modeling examined the pattern of recovery and the effect of cognitive status.Results: Of the 383 participants, 104 (27%) had Mini-Mental Status Examination scores of less than 18. The effect size for changes in the FIM over 6 months was large for those without cognitive impairment (effect size = 2.3) and smaller for those with cognitive impairment (effect size = 0.9). After adjusting for age, gender, proxy respondent, and fracture type, participants with impaired cognition recovered more slowly, never attaining comparable levels with those without cognitive impairment. The 6-month health status for the cohort was substantially lower than the health status of age-gender-matched, community-dwelling adults.Conclusions: Patients with cognitive impairment who fracture their hips recover more slowly and achieve less functional recovery. Recovery is not uniform nor is it linear over the initial 6 months. The diversity of patient needs should be recognized postoperatively so that long-term recovery is optimized. [ABSTRACT FROM AUTHOR]

After sustaining burn injuries overseas, U.K. Armed Forces personnel are evacuated to the Royal Centre for Defence Medicine. The objective was to review the etiology of U.K. Military burns managed at the center between 2008 and 2013. Analysis will aid provision planning and assist in the prevention of burn injuries for future tours. The International Burn Injury Database database of all U.K. Armed Forces burn injured patients evacuated to the Queen Elizabeth University Hospital Birmingham between 2008 and 2013 were reviewed retrospectively. Analysis included patient demographics, injury mechanism, burn severity, management, and mortality. There were 65 military personnel with burn injuries requiring repatriation to the United Kingdom. Percentage of 78.5 were sustained in Afghanistan. The mean age was 25 (18-46) years. Percentage of 70.8 were considered noncombat burn injuries. Of the noncombat burns, the mechanism of injury most commonly involved burning waste and misuse of fuels and scalds. The mean TBSA for all patients was 6% (0.05-51%). Areas most commonly affected included arms, legs, and face. The length of hospital stay for combat vs noncombat burn injury patients was 10 vs 7 days. There were no fatalities. In conclusion, substantially fewer military personnel sustained combat burns between 2008 and 2013 than in preceding study period (19 vs 79). The number of accidental noncombat burns remained constant. The decrease in combat burns may reflect a relative decrease in military intensity and effective protective equipment and safety measures. Further education may allow for an additional decrease in preventable burn injuries. [ABSTRACT FROM AUTHOR]

Burn scar contractures (BSCs) are a frequently recognized problem for survivors of burn injury. In the burn literature, many reports focus on the frequency and factors associated with the BSC development. To the contrary, few burn rehabilitation publications report on patients who are able to successfully avoid developing BSC. From a prospective, multicenter study, data were extracted and reviewed on a group of 56 adult burn survivors who were discharged from their acute hospitalization without any measured BSCs. Forty-three variables with a recognized or presumed association with the development of BSCs were analyzed and are reported. Highlighted features of the noncontracted group included being an adult male with an educated background and few associated physical, medical, or social problems. The group had relatively small burn sizes that nonetheless required hospitalization. Despite the overall TBSA, the majority of the burn areas required skin grafting, although this area also represented a small area. The patient group had a longer than expected hospital stay. Rehabilitation was provided to patients on 80% of their hospital days. In addition, patients received sufficient rehabilitation treatment based on the number of cutaneous functional units involved in the burn injury. Patients were judged to have a high pain tolerance and compliant with rehabilitation. The results of this study document the clinical circumstances that patients with burn injury can be discharged from their acute hospitalization with the development of BSC. This study challenges the rehabilitation personnel to expand the upper limit of burn severity that can result in similar positive outcomes. [ABSTRACT FROM AUTHOR]

Background. Virtual reality (VR) training is considered to be a promising novel therapy for balance and gait recovery in patients with stroke. Purpose. The aim of this study was to conduct a systematic literature review with meta-analysis to investigate whether balance or gait training using VR is more effective than conventional balance or gait training in patients with stroke. Data Sources. A literature search was carried out in the databases PubMed, Embase, MEDLINE, and Cochrane Library up to December 1, 2015. Study Selection. Randomized controlled trials that compared the effect of balance or gait training with and without VR on balance and gait ability in patients with stroke were included. Data Extraction and Synthesis. Twenty-one studies with a median PEDro score of 6.0 were included. The included studies demonstrated a significant greater effect of VR training on balance and gait recovery after stroke compared with conventional therapy as indicated with the most frequently used measures: gait speed, Berg Balance Scale, and Timed "Up & Go" Test. Virtual reality was more effective to train gait and balance than conventional training when VR interventions were added to conventional therapy and when time dose was matched. Limitations. The presence of publication bias and diversity in included studies were limitations of the study. Conclusions. The results suggest that VR training is more effective than balance or gait training without VR for improving balance or gait ability in patients with stroke. Future studies are recommended to investigate the effect of VR on participation level with an adequate follow-up period. Overall, a positive and promising effect of VR training on balance and gait ability is expected. [ABSTRACT FROM AUTHOR]

Background: Returning to work (RTW) after long-term sickness absence is a challenge for convalescent workers, co-workers, managers and organizations. Few studies have investigated the post-return phase after long-term sickness absence. Aims: To investigate the RTW process as experienced by returning workers, co-workers and managers at an emergency care service and a waste disposal company, exploring various perspectives related to early RTW before full recovery and changes in the returning workers' work positions. Methods: An ethnographic field work design was employed. Returning workers with musculoskeletal disorders, co-workers and managers at two different workplaces participated in individual and group interviews and underwent participant observation over 5 months. These were repeated in a 2-week period after a 4-month interval. Grounded theory analysis was used to identify themes of importance. Conclusions: Our results illustrate how returning workers, co-workers and managers at two workplaces experienced the RTW process. The results highlight some of the challenges that occur when returning at an early stage before full recovery is obtained leading to changes in the returning worker's work position. [ABSTRACT FROM AUTHOR]

Aims: Mechanical stimulation (MS) represents a readily available, non-invasive means of pacing the asystolic or bradycardic heart in patients, but benefits of MS at higher heart rates are unclear. Our aim was to assess the maximum rate and sustainability of excitation by MS vs. electrical stimulation (ES) in the isolated heart under normal physiological conditions.Methods and Results: Trains of local MS or ES at rates exceeding intrinsic sinus rhythm (overdrive pacing; lowest pacing rates 2.5±0.5 Hz) were applied to the same mid-left ventricular free-wall site on the epicardium of Langendorff-perfused rabbit hearts. Stimulation rates were progressively increased, with a recovery period of normal sinus rhythm between each stimulation period. Trains of MS caused repeated focal ventricular excitation from the site of stimulation. The maximum rate at which MS achieved 1:1 capture was lower than during ES (4.2±0.2 vs. 5.9±0.2 Hz, respectively). At all overdrive pacing rates for which repetitive MS was possible, 1:1 capture was reversibly lost after a finite number of cycles, even though same-site capture by ES remained possible. The number of MS cycles until loss of capture decreased with rising stimulation rate. If interspersed with ES, the number of MS to failure of capture was lower than for MS only.Conclusion: In this study, we demonstrate that the maximum pacing rate at which MS can be sustained is lower than that for same-site ES in isolated heart, and that, in contrast to ES, the sustainability of successful 1:1 capture by MS is limited. The mechanism(s) of differences in MS vs. ES pacing ability, potentially important for emergency heart rhythm management, are currently unknown, thus warranting further investigation. [ABSTRACT FROM AUTHOR]

Background. Intravenous infusion of mesenchymal stem cells (MSCs) derived from adult bone marrow improves behavioral function in rat stroke models. Rehabilitation therapy through physical exercise also provides therapeutic efficacy for cerebral ischemia. Objective. The purpose of this study was to investigate whether synergic effects of daily rehabilitation and intravenous infusion of MSCs has therapeutic effects after stroke in rats. Design. This was an experimental study. Methods. A permanent middle cerebral artery occlusion (MCAO) was induced by intra-luminal vascular occlusion with a microfilament. Four experimental groups were studied: group 1 (vehicle only, n=10), group 2 (vehicle + exercise, n = 10), group 3 (MSCs only, n=10), and group 4 (MSCs + exercise, n=10). Rat MSCs were intravenously infused at 6 hours after MCAO, and the rats received daily rehabilitation with treadmill running exercise for 20 minutes. Lesion size was assessed at 1, 14, and 35 days using magnetic resonance imaging. Functional outcome was assessed using the Limb Placement Test. Results. Both combined therapy and MSC infusion reduced lesion volume, induced synaptogenesis, and elicited functional improvement compared with the groups without MSC infusion, but the effect was greater in the combined therapy group. Limitations. A limitation of this study is that the results were limited to an animal model and cannot be generalized to humans. Conclusions. The data indicate that the combined therapy of daily rehabilitation and intravenous infusion of MSCs improved functional outcome in a rat MCAO model. [ABSTRACT FROM AUTHOR]

Background. Heightened awareness of the lasting effects of mild traumatic brain injury (mTBI) has amplified interest in interventions that facilitate recover)' from persistent post-mTBI symptoms. Purpose. The purpose of this study was to systematically review the literature to identify potential physical rehabilitation interventions that are safe, feasible, and appropriate for physical therapists to utilize with patients with persistent mTBI-related symptoms. Data Sources. The electronic databases PubMed, Cochrane Library, CINAHL, Scopus, SPORTDiscus, and Web of Science were systematically searched from database inception until June 2015. Study Selection. Studies were included if they utilized physical rehabilitation interventions and the study's participants had a diagnosis of mTBI, a mean age of 8 years or older, and symptoms persisting an average of 2 weeks or longer. Exclusion criteria included blast injuries, diagnosis of moderate or severe TBI, or psychosis. Data Extraction. Data extraction and methodological risk of bias assessments were performed for each study. Data Synthesis. Eight studies with a range of study designs, intervention types, and outcome measures were included. The interventions investigated by the included studies were categorized into 3 types: physiological, vestibulo-ocular, and cervicogenic. Limitations. The identified studies had several significant limitations including: small sample sizes and low-level study designs. Conclusions. The results of this systematic review indicate that several physical rehabilitation options with minimal risk for negative outcomes are available for treating patients experiencing persistent post-mTBI symptoms. These options include: vestibular, manual, and progressive exercise interventions. Conclusions surrounding efficacy and ideal dosing parameters for these interventions are limited at this time due to the small number of studies, the range of interventional protocols, and lower levels of study design. [ABSTRACT FROM AUTHOR]

Objectives: Skin is an important exposure route for isocyanate chemicals and contributes to systemic sensitization. Methods for assessing skin exposure are currently limited and generally rely upon removal (e.g. tape-strip) techniques prone to underestimation. The aim of this study is to (i) develop and field test an interception-based hand exposure sampler to monitor potential skin exposure to isocyanates in the workplace, (ii) to develop an analytical method based on ultra-high-performance liquid chromatography--UV absorbance--tandem mass spectrometry (UHPLC--UV--MS/MS) for analyzing glove samples; and (iii) compare it with tape-stripping skin sampling method. Methods: Laboratory investigations assessed different glove materials/fabrics, methods for impregnating with 1-(9-anthracenylmethyl)piperazine (MAP) derivatizing agent, methylene diphenyl diisocyanate (MDI) uptake and recovery, and durability. Following use, gloves were dissected into sections corresponding to different spatial regions (finger, palm) and analyzed using a newly developed UHPLC-UV-MS/MS method capable of differentiating and quantitating different MDI isomers with high sensitivity. Performance of the glove sampler was further assessed in a pilot field study using six workers. Results: A MAP-impregnated thin cotton glove sampler and UHPLC--UV--MS/MS analytical method for detecting MDI were successfully developed in laboratory studies. In subsequent field studies, a total of 384 samples from 14 glove pairs identified full-shift exposures ranged from 0.01 to 306 µg of 4,4'-MDI/worker for each hand. Surface area adjusted MDI values measured with the glove sampler (0.13-572 ng MDI cm-2) were considerably higher (~400-fold) than values obtained with tape stripping. Conclusion: A glove sampler and a novel UHPLC-UV-MS/MS analytical method were developed to quantitatively measure MDI skin exposure. The novel interception technique overcomes inherent limi- tations of removal techniques for measuring isocyanate skin exposure and may be useful in exposure surveillance and future research on isocyanate's health risks. [ABSTRACT FROM AUTHOR]

Unilateral spatial neglect is a common neurological syndrome following predominantly right hemispheric stroke. While most patients lack insight into their neglect behaviour and do not initiate compensatory behaviours in the early recovery phase, some patients recognize it and start to pay attention towards the neglected space. We aimed to characterize visual attention capacity in patients with unilateral spatial neglect with specific focus on cortical processes underlying compensatory gaze shift towards the neglected space during the recovery process. Based on the Behavioural Inattention Test score and presence or absence of experience of neglect in their daily life from stroke onset to the enrolment date, participants were divided into USN+‰‰+ (do not compensate, n = 15), USN+ (compensate, n = 10), and right hemisphere damage groups (no neglect, n = 24). The patients participated in eye pursuit-based choice reaction tasks and were asked to pursue one of five horizontally located circular objects flashed on a computer display. The task consisted of 25 trials with 4-s intervals, and the order of highlighted objects was randomly determined. From the recorded eye tracking data, eye movement onset and gaze shift were calculated. To elucidate the cortical mechanism underlying behavioural results, electroencephalagram activities were recorded in three USN+‰‰+, 13 USN+ and eight patients with right hemisphere damage. We found that while lower Behavioural Inattention Test scoring patients (USN+‰‰+) showed gaze shift to non-neglected space, some higher scoring patients (USN+) showed clear leftward gaze shift at visual stimuli onset. Moreover, we found a significant correlation between Behavioural Inattention Test score and gaze shift extent in the unilateral spatial neglect group (r = -0.62, P < 0.01). Electroencephalography data clearly demonstrated that the extent of increase in theta power in the frontal cortex strongly correlated with the leftward gaze shift extent in the USN+‰‰+ and USN+ groups. Our results revealed a compensatory strategy (continuous attention to the neglected space) and its neural correlates in patients with unilateral spatial neglect. In conclusion, patients with unilateral spatial neglect who recognized their own neglect behaviour intentionally focused on the neglected space as a compensatory strategy to avoid careless oversight. [ABSTRACT FROM AUTHOR]

The authors introduce a conceptual model to study pain with movement first by presenting a historical overview that identify existing bodies of knowledge that should be integrated to consider pain as a nervous system disease and proposing a model for integrating pain with movement. This model for integrating pain with movement is said to encourage an integrated research approach that emphasizes a dynamic relationship among nervous pain processing and recovery.

Background: Anglophone nurses face the challenge of communicating health information to patients who do not speak or understand English. Limited English-proficient patients are at higher risk of misinterpreting health information teaching. Successful recovery after coronary artery bypass graft surgery requires patients’ engagement with healthcare professionals and active participation in therapies and related undertakings. Determination of whether limited English-proficient patients undergoing coronary artery bypass graft surgery recover at the same pace as the general population is of interest. Aim: This study examined whether limited English-proficient patients had prolonged post-operative length of stay following coronary artery bypass graft surgery. The patients’ length of stay with regard to a clinical pathway target was also examined. Method: A retrospective medical record review of all patients undergoing isolated coronary artery bypass graft surgery in a 2-year period was conducted. A screening tool was developed to identify limited English-proficient patients through examination of their medical records. Results: A total of 691 of 712 (97.1%) patients met the inclusion criteria; 103 (14.9%) patients were identified as limited English-proficient. The post-operative median length of stay of limited English-proficient patients was 7 days compared with 6 days for the English-proficient patients (p = 0.007). Limited English-proficient patients had higher infection rates (29.1%) vs. English-proficient patients (16.7%) (odds ratio = 2.05 (95% confidence intervals 1.27–3.30)). Post-operative infection was the strongest predictor of length of stay and fully mediated the relationship between language proficiency and length of stay. Conclusion: When compared with English-proficient patients, limited English-proficient patients had greater infection rates, which were associated with longer length of stay. These findings warrant examination of the mechanisms through which post-operative infections are acquired by limited English-proficient patients. [ABSTRACT FROM AUTHOR]

We read with interest the paper by Koda I et al i .[1] entitled 'Randomized trial of granulocyte colony-stimulating factor for spinal cord injury'. However, the manner in which the results are presented - and I post hoc i subgroup analyses performed - would suggest that the mixed-effect model described in the protocol was not used. Study participants, who were in the acute phase of their spinal cord injury, enrolled in the trial in the hope that, in the future, others who sustain a spinal cord injury would have improved outcomes. [Extracted from the article]

Héroux I et al i .[1] have highlighted their concerns about the statistical presentation and interpretation of the data described in our paper.[2] A large part of the authors' criticism is appropriate. The replies to the authors' comments are as follows: As the authors pointed out, in Table 1 of our article, the male/female ratio of patients in the placebo group was 40:5. [Extracted from the article]

Background. Chiropractors throughout the world by and large focus on patients with musculoskelctal complaints who are generally in good health. Currently, it is widely accepted that neck pain and low back pain are best understood as biopsychosocial phenomena. Objective. The purpose of this study was to determine whether certain psychosocial factors provide added value for predicting recovery. Design. This was a prospective, multicenter, chiropractic, practice-based cohort study in Belgium and the Netherlands. Methods. A total of 917 participants, 326 with neck pain and 591 with low back pain, completed self-administered questionnaires at baseline and at 3, 6, and 12 months. They provided information on several demographic, biomedical, and psychosocial variables. Lasting perceived recovery was used as the outcome measure, that is, recovery at all follow-up assessments from 3 months on. Twenty-seven potential predictors of outcome were used to build the predictive model. Stepwise, backward generalized estimating equation regression models were used to take into account the clustering of participants within practices. For assessment of the added value of psychosocial variables, 2 model fit indexes were compared. Results. After the addition of psychosocial variables, predictors in the final model for neck pain included occupational status, body mass index, duration of complaints, previous treatment, and participant expectations (the model fit was marginally improved from 0.684 to 0.695 for the area under the curve and from 65.0% to 66.1% for the percentage correctly predicted). In the final model for low back pain, the selected predictors included country of treatment, age, duration of complaints, previous imaging, and somatization (the area under the curve changed from 0.669 to 0.715, and the percentage correctly predicted changed from 68.6% to 69.5%). Only a minority of participants had high scores on psychological variables. Limitations. The reliability and validity of lasting recovery as an outcome measure have not been tested. The cohort needs to be seen as a convenience sample. Selection bias, therefore, not be ruled out. There are no indications, however, that patients with complex psychosocial profiles were excluded from this study. Conclusions. Psychosocial variables provided little added value for predicting outcome in people who had neck pain or low back pain and sought chiropractic care. Therefore, chiropractors should not screen extensively for them at baseline. With regard to the identification of the small subgroup of people with high scores on psychosocial variables and a high risk for chronic pain, further investigation is needed. [ABSTRACT FROM AUTHOR]