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Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation in the intensive care unit. The incidence, patient characteristics, and outcomes have not been described in a regional Australian setting.Τhe primary objective was to establish the incidence of VAP in a regional intensive care unit using predetermined diagnostic criteria. The secondary objective was to compare the agreement between criteria-based and physician-based diagnostic processes. The tertiary objectives were to compare patient characteristics and clinical outcomes of cases with and without VAP.A retrospective clinical audit was performed of adult patients admitted to Rockhampton Intensive Care Unit, Australia, between 2013 and 2016. We included all patients ventilated for ≥72 h and not diagnosed with a pneumonia before or during the first 72 h of ventilation.A total of 170 cases met the inclusion criteria. The incidence of VAP as per the criteria-based diagnosis was 27.3 cases per 1000 ventilator days (95% confidence interval [CI]: 18.4-36.2) and as per the physician-based diagnosis was 25.8 cases per 1000 ventilator days (95% CI: 17.1-34.4). There was a moderate chance-corrected agreement between the criteria- and physician-based diagnosis. Very obese cases (body mass index [BMI] ≥40) were nearly four times more likely to develop VAP than cases with normal BMI (BMI30) (odds ratio: 3.664; 95% CI: 1.394-9.634; p = 0.008). After controlling for sex, BMI category, comorbidities, and Acute Physiology and Chronic Health Evaluation II scores, there was a trend (p = 0.283) for higher adjusted mortality rate for cases with VAP (10.1%, 95% CI: 4.8-21.5) than for those without VAP (6.1%, 95% CI: 3.0-12.4). Cases with VAP had a higher total hospital cost ($123,223 AUD vs $66,425 AUD, p 0.001), than cases without VAP.This is the first study reporting incidence of VAP in an Australian regional intensive care unit setting. An increased length of stay and significantly higher hospital costs warrant research investigating reliable and valid clinical prediction rules to forecast those at risk of VAP.

BackgroundThis first report of the Linköping Covid-19 Study (LinCoS) aimed at determination of Covid-19-associated mortality, impairments, activity and participation limitations denoting rehabilitation needs four months after discharge from hospital.MethodsAn ambidirectional population-based cohort study including all confirmed Covid-19 cases admitted to hospital during 1/03-31/05 and those living in home healthcare settings identified through a regional registry and evaluated through medical records, including WHO Clinical Progression Scale (CPS). All patients discharged from hospital were followed-up by structured telephone interview at 4 months post-discharge. Respondents indicated any new or aggravated persisting problems in any of 25 body functions and 12 activity/participation items and rated them for impact on daily life.FindingsOut of 734 hospitalised patients, 149 were excluded, 125 died, and 460 were alive at 4-month follow-up of whom 433 (94.1%) were interviewed. In total, 40% reported impairments and activity/participation limitations affecting daily life and warranted further multi-professional rehabilitation assessment, predominantly those with severe disease and a considerable proportion of those with moderate disease. Cognitive and affective impairments were equally common in all groups and were reported by 20-40% of cases. Limb weakness was reported by 31%, with CPS 7-9 being four times more likely to report this problem as compared to CPS 4-5. 26% of those working or studying reported difficulties returning to these activities, this being 3.5 times more likely in CPS 7-9 as compared to CPS 4-5. 25% reported problems walking >1 km, with CPS 7-9 over three times more likely to report this as compared to the other two sub-groups. 90-day mortality rate of Covid-19 associated deaths was 15.1%.InterpretationMost rehabilitation needs after Covid-19 involved higher cerebral dysfunction both in patients with moderate and severe disease. This should be considered when designing services aiming at minimizing long-term disability.FundingALF grant and Region Östergötland.

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). 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). 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. Pre-operative education does not reduce hospital costs (surgery and hospital stay) in Central Queensland.

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.

Prospective cohort study with a repeated measures analysis. To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation. The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals. Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17). Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up. Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.

Systematic review and meta-synthesis of qualitative findings. To establish the perceived effectiveness and mechanisms of community peer-based programmes based on narratives of consumers with spinal cord injury (SCI). Scopus, Academic Search Complete, CINAHL, Health Source, Medline, PsycARTICLES, PsychINFO, SPORTSDiscus and ProQuest were searched for articles published in English between January 1990 and December 2015. Qualitative studies referring to community peer-based interventions were included if most cases had a SCI. The results section of included studies was extracted and entered in NVivo. Data were inductively coded and analysed according to the three phases of Thematic Synthesis. The search yielded 1402 unique records, out of which 126 were scrutinised in full. Four studies were appraised based on eight criteria and were finally included in the analysis. Three analytical themes emerged: (1) a unique learning environment created by the right mixture of learning resources, learning processes and a can-do attitude; (2) peer mentors—a unique learning resource with high level of relatedness that eases and empowers participants; and (3) an intervention that responds to important unmet needs and unrealised potential. Community peer-based programmes for people with SCI provide individualised training in important life areas, using a variety of learning resources and a plethora of learning processes. The high level of perceived effectiveness suggests that this type of intervention is an important tool of health systems post discharge from initial rehabilitation. Community organisations should be supported with evaluating their programmes through quality research.

Publisher's version (útgefin grein), Objective: To explore self-reported health problems and functional goals in community-dwelling individuals with spinal cord injury in Sweden. Design: Cross-sectional descriptive study that used a survey designed by an experienced peer mentor with spinal cord injury. Subjects: Community-dwelling individuals with spinal cord injury from Sweden. Methods: The survey was distributed online by the community peer-based organization RG Active Rehabilitation. Results: A total of 203 individuals (55% males, 90% acquired spinal cord injury) from all regions in Sweden completed the survey. Of these, 33% reported living with > 2 unbearable physical or psychological problems. While some problems (e.g. problems related to bladder and balance) were consistently ranked to be common across all years since injury and type of spinal cord injury, distribution of some other unbearable problems (e.g. type of pain, excessive weight) varied between subgroups. Years since injury, level of acquired spinal cord injury and sex, but not age-group or type of spinal cord injury, explained some of the variation in the goals. Conclusion: The high proportion of reported “unbearable” problems point to the stronger need for systematic, comprehensive, life-long, multi-disciplinary follow-up for people with spinal cord injury. The high rate of goals related to improving strength and fitness across all participants independently of their characteristics highlight the important role of community organizations that offer such lifetime services.

An increasing number of universities offer educational programmes across multiple campuses, as a way of facilitating access to tertiary education and filling the shortage of health professionals in rural and regional settings. Offering an equitable learning experience across all sites has been considered an important aspect in any learning and teaching approach. This qualitative study analysed data from 10 focus group discussions and 11 unit evaluations, to explore student perceptions of synchronous dual-campus delivery of a physiotherapy programme in Central Queensland, Australia. An inductive approach to thematic analysis was used. Three themes emerged: (a) Student location influences learning; (b) Videoconferencing impacts learning and teaching; and (c) Dual-campus delivery determines teaching structures and shapes teaching processes. Difficulties related to cross-campus communication, logistics, and opportunities for interaction and engagement were seen as detrimental to synchronous dual-campus delivery. Skill-based demonstrations added another level of complexity. However, students identified a potential benefit from accessing expertise from both campuses. With careful planning and consideration of the potential barriers and facilitators, synchronous dual-campus learning environments can be an effective delivery option for higher education institutions. This study builds on existing literature and suggests a number of strategies that are specific to this mode of programme delivery.

IntroductionVentilator-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 analysisThis 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 disseminationThis 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.

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.

Myasthenia gravis (MG) is a neuromuscular disorder in which antibodies are directed against the nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. Some investigators describe the existence of oligoclonal IgG bands and anti-AChR antibodies in the cerebrospinal fluid (CSF) of MG patients while other refuse it. This study was performed in 15 patients with clinical and electrophysiological diagnosis of MG. Oligoclonal IgG bands (OCB) and antibodies to the AChR from human skeletal muscle were determined in the serum and the CSF of the above MG patients. The last one was done in order to investigate any possible central nervous system (CNS) involvement. It was found that all the MG patients who had a high titre of anti- AChR antibodies in the serum (mean titre 29.2±24.3 nM, range 1.8 to 62 nM) did not present OCB and anti-AChR antibodies in their CSF. On the same time, in a group of 10 patients with a definite multiple sclerosis it was found that eight of them presented OCB in their CSF while the results were negative in another group of 10 patients without evidence of CNS disease. The last two groups served as control groups. Our findings are in accordance with the concept that MG is a pure neuromuscular disorder.

Little is known about the possible impact of the system of care on mortality during the first year after acute traumatic spinal cord injury (TSCI).To evaluate late mortality (i.e.,7 days after trauma) during the first year after acute TSCI in 2 European Union (EU) regions, Thessaloniki in Greece and Stockholm in Sweden.This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS), which is a prospective, population-based study. Incidence cohorts of TSCI cases were identified and followed up in both study regions through STATSCIS. Data from Thessaloniki region were collected through physical examination, medical records review, and interviews with TSCI individuals and the medical teams. Data from Stockholm were retrieved mainly from the Nordic Spinal Cord Injury Registry, as well as from direct contact with all intensive care facilities of the region.The annual case mortality rate after acute TSCI was nearly 20% in Thessaloniki and 0% in Stockholm. The mean time of survival after trauma for the 12 mortality cases of Thessaloniki was 47 days (median = 24, SD +/- 67, range = 8-228). Factors associated with mortality were higher age and presence of comorbid spinal disorders but also the inefficient transfer logistics, initially missed spinal instability, and unsuccessfully treated complications.The annual case mortality rate in Thessaloniki was dramatically higher than in Stockholm. The different approaches to care, one systematic and the other not, is postulated to be an important factor leading to such major discrepancies between the outcomes of these 2 EU regions.