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Establishing accurate mathematical models of outcome measures is essential in understanding change throughout the rehabilitation process. The goal of this study is to identify the best-fitting descriptive models for a set of commonly adopted outcome measures found within the Traumatic Brain Injury Model Systems National Database where the modeling is based on data submission through 2011 and the complete range of recorded time points since injury for each individual, where time points range from admission to rehabilitation to 20 years postinjury. The statistical methodology and the application of the methodology contained herein may be used to assist researchers and clinicians in (1) modeling the outcome measures considered, (2) modeling various portions of these outcomes by stratification and/or truncating time periods, (3) modeling longitudinal outcome measures not considered, and (4) establishing models as a necessary precursor in conducting individual growth curve analysis., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

The abundance of time-dependent information contained in the Spinal Cord Injury and the Traumatic Brain Injury Model Systems National Databases, and the increased prevalence of repeated-measures designs in clinical trials highlight the need for more powerful longitudinal analytic methodologies in rehabilitation research. This article describes the particularly versatile analytic technique of individual growth curve (IGC) analysis. A defining characteristic of IGC analysis is that change in outcome such as functional recovery can be described at both the patient and group levels, such that it is possible to contrast 1 patient with other patients, subgroups of patients, or a group as a whole. Other appealing characteristics of IGC analysis include its flexibility in describing how outcomes progress over time (whether in linear, curvilinear, cyclical, or other fashion), its ability to accommodate covariates at multiple levels of analyses to better describe change, and its ability to accommodate cases with partially missing outcome data. These features make IGC analysis an ideal tool for investigating longitudinal outcome data and to better equip researchers and clinicians to explore a multitude of hypotheses. The goal of this special communication is to familiarize the rehabilitation community with IGC analysis and encourage the use of this sophisticated research tool to better understand temporal change in outcomes., (Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine whether use of neighborhood characteristics derived from U.S. Census Bureau information contributes to the prediction of outcomes after traumatic brain injury (TBI) beyond the variance accounted for by individual characteristics., Design: Cross-sectional analysis of follow-up interviews conducted 1, 2, and 5 years postinjury., Setting: Twelve Traumatic Brain Injury Model Systems (TBIMS) centers., Participants: Patients 16 years of age and older with moderate or severe TBI enrolled in the TBIMS National Database (N=472)., Interventions: None., Main Outcome Measures: Satisfaction With Life Scale and Participation Assessment with Recombined Tools-Objective., Results: Individual characteristics alone accounted for 26% and 48% of variance in life satisfaction and participation, respectively; neighborhood characteristics alone accounted for 6% and 9% of variance, respectively. Models combining both types of characteristics included significant neighborhood and individual predictors for participation but not life satisfaction; however, for participation, prediction only improved beyond that found for individual characteristics alone by 1.2%., Conclusions: The results did not support the hypotheses that characteristics of a person's neighborhood would increase outcome prediction beyond that which can be accomplished based on characteristics of the individual alone. Though neighborhood characteristics were statistically significant in prediction models, the improvement in percent of variance accounted for was negligible. Refinements in conceptualization and methodology are suggested for continued exploration of the contribution of neighborhood characteristics to TBI outcomes., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Venous thromboembolism (VTE) remains a clinical problem in surgical oncology. We report the impact of preoperative initiation of subcutaneous heparin on VTE events after pancreatic surgery., Methods: A retrospective cohort study of patients undergoing pancreatic surgery by a single surgeon and enrolled in the American College of Surgeons National Surgery Quality Improvement Program database (FY09/10) was performed. In FY10, a protocol was developed to encourage the use of preoperative pharmacoprophylaxis for high-risk patients. We compared patient characteristics before and after implementation of the protocol. Our primary outcome was 30-day VTE rate and secondary outcomes were bleeding events and 30-day mortality. Outcomes were compared by Student's t-test and Fisher's exact test., Results: Seventy-three patients were studied, 34 patients underwent surgery before and 39 had surgery after implementation of the protocol. All patients received intra-operative intermittent compression boots (ICB) and postoperative pharmacoprophylaxis. Patients in the two groups were statistically equivalent with respect to age, body mass index, procedure length, and VTE risk factors. The percentage of patients with a VTE event decreased significantly after the protocol (17.6% vs. 2.6%, P=0.035). The mean number of units of red blood cells transfused in the OR was not statistically different (0.4 vs. 0.7, P=0.43.) Two patients returned to the operating room for bleeding after the implementation of the protocol. There were no deaths., Conclusions: Intraoperative ICBs with postoperative initiation of subcutaneous heparin pharmacoprophylaxis may be inadequate for VTE prophylaxis for high risk patients. The use of a preoperative dose of subcutaneous heparin in high-risk pancreatic surgery patients resulted in a statistically significant reduction of VTE events.

The medical supplies appropriate for travel will quite naturally depend on the individual and on the nature, scope, and duration of the trip being planned. A basic kit containing nonmedicinal supplies, nonprescription drugs, and prescription medications can be a starting point in planning for both lay and physician travelers, however. Although medical responsibility for assisting in emergency situations during travels as well as liability differ from location to location, in general the physician should not hesitate to give aid in perceived situations of need.

Several risks can be posed by travel, even when the stay is not protracted nor the destination exotic. Air travelers should consider the potential problems associated with decreased cabin pressure, hypoxia, and circadian dysrhythmia, problems that can contraindicate flying for some. Motion sickness can affect those traveling by air, sea, or land; medications are available to combat the symptoms, and several other remedies such as changing visual stimuli are also worth trying. Persons staying in hotels, particularly high rises, should review several general guidelines for defensive action in case of fire and should become familiar with the physical layout and escape routes of the building in which they are staying.

Various medical conditions--cardiovascular and pulmonary problems, thrombosis, diabetes, and others--can present special risks and/or problems in travel. These should be discussed as part of a thorough predeparture evaluation with affected patients who are planning overseas travel. In addition, certain travelers may require medical follow-up on their return. Various travel medicine resource organizations, booklets, and books should be made known to all travelers.

North American mission boards were surveyed to identify and prioritize missionary medical problems and determine initiatives for improving health. Malaria was the most common nontrivial medical complaint, and viral hepatitis the most serious. Nevertheless, only 72 percent of boards recommend malaria prophylaxis, 57 percent ascribe to regular immune globulin use, and 31 percent advocate hepatitis B immunization. Sub-Saharan Africa was considered the region of the world where missionary health was most in peril. Besides strategies to minimize the risks of malaria and hepatitis, recommendations for improving missionary health include greater use of rabies and typhoid vaccines; increased attention to mental health concerns and accident prevention, particularly seat belt use; increased health education regarding both clinical issues and public health principles; improved scheduling for relaxation and family time; and greater availability of comprehensive health services before departing, while abroad, and upon returning from an overseas assignment.

A seroepidemiologic survey was conducted in 25 clinical and 31 nonclinical personnel engaged in substance abuse research and treatment. The antibody to hepatitis A virus (anti-HAV) was identified in 16 percent of the clinical employees and 39 percent of the nonclinical personnel, for a total prevalence of 29 percent. The prevalence of anti-HAV was age related, and the overall frequency was not greater than expected attack rates. Hepatitis B virus (HBV) markers were present in 16 percent of the clinical personnel tested but in only 3 percent of nonclinical personnel, for a total prevalence of 9 percent among the two groups. The nonclinical risk did not exceed the background prevalence of the disease, but the risk for clinical employees was three to five times greater. This risk appeared to be associated with exposure to blood and other potentially infectious body fluids; however, in no case could an employee with HBV markers recall a percutaneous injury, and covert means of transmission could not be excluded. Only one case (20 percent) of HBV infection manifested clinical symptomatology. Even though proper environmental safety measures may decrease the incidence of HBV infection in at-risk groups, some health care workers and researchers in the field of substance abuse may be at sufficiently increased risk of HBV infection to warrant immunization with hepatitis B vaccine.

Physicians counseling patients who are planning major travels should make sure that baseline immunizations (diphtheria-tetanus-pertussis, polio, measles, rubella) and any necessary boosters are current. In addition, several other immunizations may be warranted (yellow fever, typhoid, and cholera), depending on destination(s) and itinerary, and prophylaxis for malaria may be advisable. As worldwide requirements for immunization do change, the physician should verify current requirements before planning an immunization schedule for a particular patient.