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Purpose. This paper reports on a 3-month post-discharge falls profile of a cohort of patients discharged home from an acute rehabilitation setting. Methods. A consecutively-sampled cohort of consenting patients was prospectively followed for 3 months after discharge from a large Australian metropolitan acute rehabilitation facility. Patients were diagnostically classified by the reason for admission. All patients completed a monthly falls diary. Each month, falls were described by severity, location, frequency and outcome. Patients also completed the World Health Organisation's quality of life (QoL-BREF) at Months 1 and 3. Results. Almost a third of the study participants fell during the study [105 fallers of 342 total (31)]. Of these, 21 fell more than once (20). There were significant differences in falls reported per diagnostic group, including frequency, impact, severity and ability to get up. Irrespective of diagnostic group, fallers had lower QoL scores compared to non-fallers. Both the neurological and orthopaedic trauma groups were most at risk of falling in Months 1 and 3, whereas in Month 2, only the neurological group was most at risk of falling. Conclusion. Falls are a fact of life for some patients during their community rehabilitation phase. Patients from different diagnostic groups have different over-time risk profiles for falling. Thus, there is no 'one-size fits all' solution for falls prevention. This study provides useful data to assist in formulating appropriate falls prevention strategies for recently ill people. Refereed/Peer-reviewed

A retrospective analysis of functional status at discharge, disposition, Glasgow Outcome Scale (GOS) score at 6 months and 1 year was undertaken for 23 consecutive 'low-level' traumatic brain injury victims admitted in a state of complete dependency to an acute rehabilitation programme. All patients met criteria for extremely severe traumatic brain injury, with an average Glasgow Coma Scale score of 8.7 at admission to the rehabilitation facility (an average of 44 days post-injury). All but three patients made significant functional gains during the acute rehabilitation stay. Almost half of the study patients (48%) were discharged at home while the rest went to sub-acute rehabilitation programmes. At 6 months post-injury eight (35%) met GOS criteria for 'good' outcome or 'moderate disability'. A review of clinical features, categories of functional progress, and relationships of outcome and disposition to variables known to have predictive value in such a patient population is described. Analysis of variables related to admission selection criteria that have been used in this rehabilitation programme is presented and the basis and implications of selection criteria discussed.

Background and Purpose— Racial disparities among US stroke patients have been well documented. However, the extent to which disparities in outcomes vary by age is unclear. This study’s goals were to examine the degree of racial disparities in South Carolina between African Americans (AAs) and Caucasian Americans (CAs) in stroke admission rates, hospital charges, and outcomes and to determine whether racial differences varied by age. Methods— From the state hospital discharge database, admissions with a primary diagnosis of stroke discharged from 2002 to 2006 were identified. Age group–specific stroke admission rates, hospital charges, length of stay, intensive care unit utilization, medical complications, and discharge disposition (in-hospital death, discharged home, discharge to rehabilitation facility) were compared between AAs and CAs by multiple-linear or logistic-regression analysis. Results— There were 58 272 stroke admissions during the 5-year period. Stroke admission rates were persistently higher for AAs in all age groups except those ≥85 years old. Hospital charges totaled $1.51 billion; 24.0% ($362.5 million) of this total was attributable to racial disparities, 70.8% ($256.5 million) of which stemmed from the 36.6% of patients Conclusions— Racial disparities in stroke admissions are more pronounced in younger age groups and result in significant economic consequences. Although AA stroke patients experienced generally worse acute outcomes than did CAs, these differences appear to be relatively consistent across age groups.

The Indiana man was a fine horseman who treasured his horses—they were almost like family to him. Then he had surgery to repair an aortic aneurysm. One of his physicians told him that he could never ride again and that he should sell his horses. Fearful of jeopardizing his life and not knowing what else to do, the man complied, but doing so plunged him into a depression that lifted only when he was well enough to see that the physician's advice was wrong. He now owns and rides horses again. Cardiac surgery patients at a major Texas hospital are told on discharge not to lift anything heavier than a half-gallon of milk (about 4 pounds). The door to the cardiac rehabilitation facility in the same hospital requires a 14-pound pull to open, yet no patients have died or have even been injured from opening this door. Do the activity restrictions that patients are given after major surgery affect their recovery? Can the activity restrictions increase the risk of morbidity? Can bad advice kill a patient who has just had a successful surgical procedure? These provocative questions are not merely theoretical; to us they are deeply personal. I (RDP) am an electrical engineer and physicist who in 2003 underwent an emergent repair of a Stanford type A dissection of the ascending aorta. Since my recovery, I have corresponded with other survivors of aortic events via a Web site. My coauthor, Dr. Adams, is an exercise physiologist and senior research associate; we worked together on the design and analysis of an experiment to improve rehabilitation of cardiac surgery patients. Through this unique combination of personal and professional experiences, we have seen that current activity guidelines often fall short. In this article, we explore possible reasons for these deficiencies and their consequences, provide examples of helpful and unhelpful advice, and offer suggestions for improving the content and delivery of postsurgical guidance.

▪ Abstract: Objective: To test the hypothesis that distal residual limbs (DRLs) have significant vasomotor abnormalities. Design: Comparative surface temperature studies of DRLs using paired samples (DRL vs. similar site on intact contralateral limb). Subjects/Patients: Thirty-six volunteer subjects with unilateral, upper or lower limb amputations were recruited and evaluated at a pain research center in an urban academic rehabilitation facility. Methods: Our main outcomes were subjects’ residual limb temperature as measured by quantitative infrared telethermography (qIRT), temperature strips, and examiner's palpation, compared with the contralateral limb. Results: The qIRT showed that the DRLs were significantly cooler than the corresponding area of the contralateral intact limbs (P

In one hospital in southern Georgia, the review and analysis of 500 peripherally inserted central catheter procedural attempts by designated, specialty nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. This research analysis also provided information on the disposition of those 6-French dual-lumen and triple-lumen, power-injectable peripherally inserted central catheters actually placed in situ on subjects who remained hospitalized or within the hospital's rehabilitation facility. Of the 422 catheters removed, none exhibited signs or symptoms of mechanical phlebitis, and one tested positive per laboratory analysis for organisms confirming infection.

Functional Capacity Evaluation (FCE) contributes to clinical decisions regarding fitness-for-work and may improve return-to-work outcomes. However, FCE is a burdensome clinical tool in terms of time and cost. We evaluated the effectiveness of a short-form FCE protocol. A cluster randomized controlled trial was conducted. Data were collected on all claimants undergoing FCE at Alberta’s workers’ compensation rehabilitation facility. Twenty-three clinicians who were trained and experienced with FCE were randomized to either an intervention or control group. The intervention group was trained to conduct short-form FCE and used this protocol through the trial’s duration, while the control group continued standard FCE procedures. Data on subject characteristics, administrative outcomes (days to suspension of time loss benefits, days to claim closure, and future recurrence) and claimant satisfaction were extracted from the WCB-Alberta computer databases. Clinicians logged time taken to complete assessments. Analysis included examining differences between groups using independent samples t tests, Cox and logistic regression. Subjects included 372 claimants of whom 173 were tested with short-form FCE. Subjects were predominantly employed (64%) males (69%) with chronic musculoskeletal conditions (median duration 252 days). Administrative recovery outcomes were similar between groups as were claimant satisfaction ratings. No statistically significant or clinically relevant differences were observed on these outcomes between groups. A 43% reduction in functional assessment time was seen. A short-form FCE appears to reduce time of assessment while not affecting recovery outcomes when compared to standard FCE administration. Such a protocol may be an efficient option for therapists performing fitness-for-work assessments.

Background: The experience and outcomes of co-locating acute stroke and stroke rehabilitation care in a district hospital were reviewed. Method: Information for patients admitted to Blacktown and Mt Druitt Hospitals before and after setting up an acute stroke unit (SU) (12 months data for each period), including mortality and length of stay (LOS) at the hospital were obtained from various sources, including the diagnosis-related group and subacute and non-acute casemix databases. Results: There was a significant reduction of mortality (18 vs 10%; P = 0.01) and reduced total LOS (46 vs 39 days; P = 0.01) with similar functional outcomes in the post-SU period. Fifty per cent of patients were unable to access the acute SU. Patients admitted into the SU had lower mortality (5 vs 14%; P = 0.01) and were also discharged from hospital earlier (35 vs 54 days; P = 0.01) than patients admitted into general wards during the post-SU period. Thirty-four per cent of patients received rehabilitation within the rehabilitation facility in the post-SU period compared with 19% in the pre-SU period. Conclusion: The Blacktown experience showed the feasibility of establishing a co-located SU within rehabilitation facility with good outcomes as illustrated by the significant reduction in the stroke mortality, a reduction in the total LOS and an increase in the number of patients receiving rehabilitation post-stroke.

This study identified problems and associated feelings experienced by family caregivers of stroke survivors during the second and third month after discharge from a rehabilitation facility to home. Safety was the most frequent problem identified by family caregivers. Other problems were managing activities of daily living (ADLs) and cognitive, behavioral, and emotional changes by stroke survivors. About half of caregivers expressed more positive feelings toward managing these problems by week 8 and the majority expressed these feelings by week 12.

78 Background: Palliative care has been shown to improve quality of life and prolong median survival in patients with advanced cancer. Sadly, patients are still suffering at the end of their lives perhaps secondary to aggressive hospital care. ICU use in the last month of life increased from 24.3% to 29.2% over the last study decade. Our objective was to evaluate and quantify outcomes, including survival, of patients with active stage IV malignancy admitted to an urban university affiliated hospital MICU who had a palliative medicine consult. Methods: A retrospective chart review of patients from 04/2013 - 04/2014 admitted to the MICU with active stage IV malignancy identified via a validated proactive case finding trigger tool. The trigger was based on eight criteria, one of which being active stage IV malignancy. The MICU census was reviewed biweekly. Data collected included pain and symptom relief, clarification of goals of care, length of stay, and disposition (hospice, rehabilitation facility, home and death). Results: Four hundred sixty eight patients were assessed. One hundred and twenty two patients met 1 of the 8 criteria, and 24 patients met the inclusion criteria for review. Three patients were not seen due to attending and/or family preference. Thirty eight percent of patients had improved symptoms and management control, 42% had clarification of goals of care and medically appropriate decision making, and 42% experienced psychosocial spiritual counseling. Eight patients died during their hospital stay, 4 were transferred to inpatient hospice facilities, 3 to rehabilitation facility, 2 went home and the remainder was “other”. The average length of stay of patients seen by palliative care was 20 days compared to 31 days for patients not seen by the palliative team. Conclusions: Nearly 40% of patients with active stage IV malignancy admitted to the MICU died during their hospital stay. We believe this study illuminates the futility of ICU care in this patient population. Consultation from the palliative medicine team using a proactive trigger tool can be beneficial to allow for better symptom control, clarification of goals and psychosocial counseling.

To describe functioning and health of elderly patients in an early post-acute rehabilitation facility and to identify the most common problems using the International Classification of Functioning, Disability and Health (ICF).Cross-sectional survey in a convenience sample of elderly patients requiring rehabilitation in an early post-acute rehabilitation facility. The second-level categories of the ICF were used to collect information on patients' problems. For the ICF components Body Functions, Body Structures and Activities and Participation, absolute and relative frequencies of impairments/limitations in the study population were reported. For the component Environmental Factors absolute and relative frequencies of perceived barriers or facilitators were reported.The mean age in the sample was 79.9 years. Sixty-nine percent of the patients were female. In 150 patients, 82 ICF categories (34%) had a prevalence of 30% or above. The 82 categories included 22 categories (45%) of the component Body Functions, six categories (15%) of the component Body Structures, 25 categories (34%) of the component Activities and Participation and 29 (57%) categories of the component Environmental Factors.This study is a first step towards the development of ICF Core Sets for geriatric patients in early post-acute rehabilitation facilities.

Purpose Patients (pts) with LVADs are challenging with issues relating to transition of care and reducing hospital length of stay. However, in severely debilitated patients this can involve transitioning to long term care facilities, subacute and acute rehabilitation facilities. Currently, there are few centers that accept patients with LVADs which indirectly affect hospital length of stay (LOS). We report the outcomes including: LOS at acute rehab facility, adverse event rate, incidence and reason for rehospitalization in a small cohort of patients discharged to acute rehabilitation facility (rehab). Methods and Materials A retrospective review of patients who were discharged to rehab from January of 2009 till October of 2012. A total of 162 LVADs were performed with 42 admissions to rehab. Results The average LOS at rehab was around 14 days without any significant difference between patients with Heart Mate (HM) II and heart ware devices. There were 12 patients transferred back to our hospital with no deaths at rehab. 30 admissions were discharged home. Patients with heart ware devices had fewer rehospitalizations compared to patients with HM II devices. Reasons for rehospitilization included GI bleeding (8 pts), Arryhthmia (1 pts) and Sepsis (3 pts). [ figure 1 ] Conclusions Patients with LVADS can be safely transitioned to an acute rehab facility with the majority of patients successfully discharged home. There were no deaths, device failures, or strokes during the rehab stay. The average LOS at rehab was 14 days. There were 12 patients readmitted to our hospital and the most common reason being anemia due to gastrointestinal bleed.

Objectives: To determine the significance of in-hospital rehabilitation facility versus distant rehabilitation facilities in the outcomes and complications of postoperative head and neck surgical patients. Methods: Retrospective review of head and neck surgical patients over a 5-year period at a tertiary care medical center. Results: Fifty patients met criteria for this study (35 males, 15 females). Forty-two patients had a primary squamous cell carcinoma, and 8 patients had other primary malignancy of the head and neck. Thirty-two patients were placed in an in-hospital rehabilitation facility, and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles; range 2–250 miles). Seventeen patients (34%) had complications including infection/drainage (7 patients), fistula (6 patients), pneumonia (2 patients), wound dehiscence (2 patients), bleeding from carotid stump, fluctuance, exudate, ulcer, eschar, delay in Blom-Singer valve teaching and displacement. The difference between the rate of complications among the 2 groups was not statistically significant (37.5% in-hospital rehabilitation, 27.8% distant rehabilitation; P = 0.496). The difference between the rate of hospital readmission was not statistically significant either (25% for in-hospital rehabilitation patients and 16.7% for distant rehabilitation patients; P = 0.505). The average length of stay of patients without complications was 18.5 days (SD = 17) for in-hospital rehabilitation and 12.9 days (SD = 5.8) for distant rehabilitation. This difference was not statistically significant (P = 0.346). Conclusion: One third of postoperative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re-admission rate, and frequency of complications does not correlate with the distance of the rehabilitation facility from the treating institution.

Many patients admitted to an inpatient rehabilitation setting experience alteration in urinary elimination as a result of neurological changes. Urinary retention can develop due to hypotonic bladder, increased sphincter tone, absent or decreased sensation of bladder fullness, or urethral blockage. Incomplete bladder emptying can lead to such complications as urinary infection and incontinence. Rehabilitation nurses must assess patients for alterations in bladder emptying. The use of bladder ultrasound is one method now available for noninvasive measurement of bladder volume. In this article, the author reviews the implementation and results of a bladder ultrasound program at one rehabilitation facility.

Malaria includes a global disease burden with approximately 300-500 million cases worldwide annually. Varied symptomatology creates a diagnostic challenge. This is a case report of a stroke rehabilitation facility resident who developed Plasmodium ovale infection, several months post-exposure. Physicians should maintain a broad list of differential diagnoses, thinking beyond the range of common diagnoses.

Trick WE, Temple RS, Chen D, Wright MO, Solomon SL, Peterson LR. Patient colonization and environmental contamination by vancomycin-resistant enterococci in a rehabilitation facility. Arch Phys Med Rehabil 2002;83:899-902. Objectives: To determine the frequency of environmental contamination in patient and common-use rooms and patient colonization by vancomycin-resistant enterococci (VRE). Design: Cross-sectional study. Setting: A 146-bed rehabilitation facility. Participants: Rectal cultures were collected from 74 (80%) of 93 patients. Environmental cultures were obtained from surfaces in 15 patient rooms (5 floors) and common-use areas on 8 floors. Interventions: Not applicable. Main Outcome Measures: Gastrointestinal colonization of patients and environmental contamination of surfaces by VRE. Results: VRE was detected from 13 (18%) of 74 patients and 32 (10%) of 319 surfaces. The frequency of positive environmental cultures varied by location; cultures were more likely to be positive in patient rooms (15%), followed by common areas on patient floors (9%) and common areas separate from patient floors (1.3%). Surfaces were more likely to be positive in rooms with a VRE-colonized patient (24%), compared with rooms in which patient colonization status was unknown (13%, P =.13) or the patient was not colonized (0%, P =.002). Surfaces were more likely to be contaminated in a room that housed an incontinent compared with continent patients (22% vs 7%, P =.01). Conclusions: Although environmental contamination by VRE was common in patient rooms, contamination of common-use areas separate from patient floors was infrequent. Despite use of common-use areas by colonized patients, isolation practices at this facility appear to have minimized environmental surface contamination in these areas. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

A significant proportion of patients on a neurosurgical service require inpatient rehabilitation placement after discharge. The relationship between the type of health insurance of the patient at the time of admission and the time to placement of patients has not previously been addressed. We prospectively studied all patients on the adult neurosurgical service at our hospital to determine whether the type of health insurance carried by patients is related to the time necessary to arrange acceptance into inpatient rehabilitation facilities. Ninety-one patients (51 men, 40 women; mean age, 56 years) admitted to the neurosurgery service during a 6-month period required inpatient rehabilitation placement after discharge. The time in days between the request for placement into a rehabilitation facility and the acceptance of the patient was examined. The mean time for placement of patients with and without health insurance at the time of admission was 0.8 days and 2.1 days, respectively (overall mean, 1.1 days) (P.002). No statistically significant associations were found between age, sex, or race of the patient and the time to placement. In addition, there was no difference in the time to placement between those patients admitted as a result of trauma and those patients admitted for reasons other than trauma. These results indicate that among patients on a neurosurgical service, patients with private health insurance are accepted into inpatient rehabilitation approximately 1 day sooner than patients without private health insurance. Patients without private health insurance are delayed in their transfer to inpatient rehabilitation facilities and more aggressive inpatient rehabilitation. How this finding translates into an increase in cost of care or a decrease in patient outcomes is unknown.

Noel Fitzpatrick founded Fitzpatrick Referrals in 1997 and currently employs more than 65 people at his state-of-the-art imaging, operative and rehabilitation facility for small animal orthopaedics and neurology in Eashing, Surrey. At least 30 of his staff are qualified veterinary nurses, or are currently in training to become RVNs. This profile concentrates on the work carried out by the nursing team, and explores the roles that each member plays within the team.

The new directors of pharmacy at the Kessler Institute for Rehabilitation were challenged to demonstrate to organizational leaders the potential benefits of clinical pharmacy services. Kessler Institute for Rehabilitation is one of the nation’s largest rehabilitation hospitals located on three

The risk for venous thromboembolic events after total joint arthroplasty is well known. Use of pharmacologic prophylaxis is recommended by many guidelines, but with pharmacologic prophylaxis comes the possibility of bleeding with a major surgical incision. With a new mobile compression device that can be worn in or out of bed, in the hospital, or at home, or a rehabilitation facility, the concern for major bleeding is eliminated, and the rate of venous thromboembolic events is similar to that of pharmacologic prophylaxis.

Objective—To establish hematologic and biochemical reference values for the brown pelican (Pelecanus occidentalis). Animals—31 captive, healthy, but permanently disabled pelicans and 35 wild-caught, healthy pelicans from a rehabilitation facility on the east coast of Florida. Procedures—Samples of venous blood were collected from each pelican, and hematologic, plasma biochemical, and electrophoretic protein analyses were performed. Student t-tests were used to compare blood values between captive versus wild-caught, adult male versus adult female, and adult versus juvenile pelicans. Results—Hematologic and electrophoretic values were similar between male and female, adult and juvenile, and captive and wild-caught pelicans. Significant sex differences existed for plasma calcium and triglyceride concentrations. Plasma concentrations of calcium, cholesterol, and CO2 content differed between captive and wild-caught adults. No significant differences were found between wild-caught adult and juvenile pelicans. Conclusions and Clinical Relevance—Our plasma biochemical results are similar to those of other brown pelicans and confamilial species. Additional studies on seabirds are encouraged, as age, sex, reproductive status, feeding habits, and captivity are important variables for health assessment in this and other aquatic species. (Am J Vet Res 2000;61:771–774)

This article discusses the impact of cognitive-communicative and behavior problems on oral intake. Data on the swallowing outcomes of a group of patients in an acute rehabilitation facility are presented. These data illustrate the relationships among severity of dysphagia, admission and discharge Functional Independence Measure (FIM) scores, admission and discharge cognitive FIM scores and length of stay. Two case studies that describe the effect of cognitive-communicative disorders on dysphagia are provided.

A prospective outcome study was performed of 100 hip fracture patients at an urban medical center in the United States. After hospitalization 19% were discharged to a rehabilitation facility and 59% were discharged home. At a mean follow-up of 8 months, 81% of patients lived at home, compared to 89% who lived at home prior to the fracture. At follow-up 71% of the patients were able to walk outside with one cane or no aids at all, and 81% were able to perform basic activities of daily living. Half of all patients did not require any home assistance at follow-up. Ten patients had died at follow-up. The goal of operatively treating the patient with a hip fracture is fixation of the fracture with a return to the patient’s pre-fracture functional ability. This study illustrates that patients with hip fractures can be effectively treated and discharged home or to a short-term rehabilitation facility with restoration of their pre-fracture functional status.

The Edwin Smith papyrus, a surgical treatise drafted nearly 4000 years ago, recounted the devastation attendant to cervical spine injuries with quadriplegia and categorized them as “ailments not to be treated.” The nihilism implied by this proscription has remained the prevailing sentiment over the succeeding millennia. Recent advances in the emergency, diagnostic, medical, and surgical management of patients with spinal cord injury (SCI), however, have infused a sense of optimism to an area that, even to this day, remains a debacle relative to the triumphs achieved in other areas of modern medicine. The acute management of the SCI patient begins at the scene of an accident the moment that such an insult is suspected, and progresses until the time of discharge to a rehabilitation facility. At each stage along this continuum, the goals of treatment remain identical

Since their inception in the late 1970s, work-hardening and work-conditioning programs have undergone metamorphoses. They have become less distinct and now offer more diverse services. This is primarily due to the ever-changing environment of health care, and the need to adapt to new consumer needs. Insurance demands, reimbursement issues, health care service trends, the adoption of disability management practices, and employee-employer relations are just a few variables influencing the practices of work-hardening and work-conditioning programs.

Purpose: This study examined pressure ulcer-prevention strategies available for patients considered at risk versus those considered not at risk. Design: The study used a prospective, longitudinal design. Setting and Subjects: Six hundred ninety-four patients from units of five acute care hospitals, a rehabilitation facility, and two nurses' home care caseloads participated in the investigation. Instruments: Data-collection instruments included the Braden Scale for risk assessment, demographic information, and the Pressure Ulcer-Prevention Strategies tool, which assessed for the presence of 16 pressure ulcer-prevention strategies. Methods: All patients admitted to a participating unit during a 2-month period were followed up until discharge. Depending on the site, patients were assessed for the presence of pressure ulcer-prevention strategies one to three times per week. Results: Patients in the at-risk group versus those in the not-at-risk group were more likely (p < 0.01) to have the head of the bed in a low position, a pressure-reducing bed surface, pressure ulcer prevention charted, a positioning wedge, incontinence cleanser and ointment, heel protection, a prevention care plan, a trapeze, and a posted turning schedule. The at-risk group had significantly (p < 0.01) more prevention strategies present than did the not-at-risk group. However, the percentage of patients placed on a pressure ulcer-prevention program was low for both groups. Conclusions: Pressure ulcer prevention was evident for the at-risk group, but at a low rate. Institutions must continue to explore this critical area affecting patient outcomes.

A $47 million marine research and rehabilitation facility being built near Prince William Sound in south central Alaska is at the center of a debate about how to spend $900 million from Exxon to help the region recover from the 40 million liters of crude oil that gushed from the supertanker Exxon Valdez in 1989. On one side are scientists, who say that studying the region`s marine mammal, sea bird, and fish genetics is the only way to obtain the data needed to protect and preserve the sound`s ecosystem. Squaring off against them are fishing industry and environmental groups, which argue that the facility is an expensive scientific toy and that the money could be better spent protecting the region by acquiring land and making it off-limits to loggers and developers. This article describes the conflicting interests and ideas about the center.

In this issue of the Journal, the reported results of two randomized clinical trials, one in Australia1 and the other in Europe,2 showed a neurologic benefit of mild therapeutic hypothermia (33°C in the first study and 32°C to 34°C in the second) in survivors of out-of-hospital cardiac arrest.3 In the Australian study, which involved a total of 77 patients who remained comatose after the restoration of spontaneous circulation, 49 percent of those treated with hypothermia were discharged home or to a rehabilitation facility, as compared with 26 percent of those not treated with hypothermia (P=0.046).1 There were no significant differences . . .

Approximately 26 short-finned pilot whales, Globicephala macrorhynchus, stranded in Cudjoe Key, FL, on May 5, 2011. Four animals, two adult and two juvenile females, were transported to a rehabilitation facility in Tarpon Basin, FL. Auditory evoked potentials (AEPs) were recorded in response to amplitude modulated tone pips modulated at 1000 Hz. AEP thresholds were determined at 10, 20, 40, 80, and 120 kHz for all the four animals. Audiograms were similar to previous findings in pilot whale hearing tests. Short-finned pilot whales have a lower peak sensitivity than other odontocetes such as bottlenose dolphins. Greatest sensitivity was 40 kHz for all whales, while thresholds for the two adults were 25–61 dB higher at 80 kHz than those for the juveniles tested. Click evoked potentials were similar between the four whales and comparable to other echolocating odontocetes. Five total pilot whales have been tested during two separate stranding events; the previously tested juvenile male was found to have profound hearing loss (Mann et al., 2010; Schlundt et al., 2011). These findings add to the limited database of pilot whale (short- and long-finned) hearing studies, of which there are only two others (Schlundt et al., 2011; Pacini et al., 2010).

A severe earthquake in December 1988 in Armenia, resulted in a large number of spinal cord injuries. A rehabilitation facility was urgently established in Yerevan by the Red Cross with volunteers from various countries outside the then Soviet Union. A programme of training of Armenian doctors, nurses and therapists was established, and a new purpose built spinal unit planned. The new unit was opened in August 1992 and should serve as a model for similar units throughout the Commonwealth of Independent States.

When crisis occurs in a healthcare facility, it involves not only the individual and his or her family, but also staff and management personnel--and personnel often are as disoriented and confused by crisis as is the individual. Healthcare providers, trained to manage the crises of others, are often at a loss when confronted with crisis in their own facility. The purpose of this article is to provide an outline of a strategy rehabilitation managers can follow in the event of a crisis in their facility.

To help map the continuum from injury to return to full function, the Functional Independence Measure (FIM) was used in an acute care setting to identify and track disability, to focus rehabilitative efforts during the acute phase of care, and to help demonstrate what is truly important in getting patients back to full functional status. A total of 109 patients were assessed over a 13-month period. FIM scores were based on a patient's ability to routinely perform certain tasks in 18 areas of function and ranged from 1 to 7. The change in FIM scores from admission to discharge was used to determine those patients to be discharged home and those patients to be discharged to a rehabilitation facility. We conclude that the FIM is a very useful tool that produced a very good measure of a patient's total function, tracked progress or lack of it through acute hospitalization, and correctly categorized and quantitated dysfunction (both cognitive and physical) as discharge planning was being done.

Thirty-seven consecutive patients with unstable pelvic fractures were divided into two groups: Group 1 (July 1981 to December 1984; n = 18), when early fixation was not routinely used, and Group 2 (January 1985 to March 1988; n = 19), when early fixation was performed unless contraindicated. Hospital stay decreased by 37.8% in Group 2 (p = 0.04). Of Group 1 patients, 60% were disabled for at least 6 months versus 15.7% in Group 2 (p = 0.001), and 45% were discharged to a rehabilitation facility versus 26.4% in Group 2. Group 1 had more complications, 1.3 per patient, versus 1.0. Patients in Group 2 (undergoing early fixation) required 27.2% fewer units of blood than those in Group 1 in whom fracture surgery was delayed. Survival was better in Group 2, 100% versus 83.3% (p = 0.06). Early pelvic fracture fixation reduces hospital stay, long-term disability, and may result in fewer complications, decreased blood loss, and better survival.

A major nursing role in rehabilitation is patient teaching. Through education, the patient is armed with knowledge that enables him or her to reenter community life prepared to be as independent as possible. The teaching in a rehabilitation facility should be evaluated continually to assure its ability to meet patients' needs. This article describes a study in which phone calls made by patients after their discharge were assessed to determine whether knowledge deficits had prompted the calls. The results were used by the hospital nursing staff to make changes in their patient teaching.

This paper outlines the process of incorporating the “Guidelines For the Client-Centred Practice of Occupational Therapy” into the practice of occupational therapy in an out-patient rehabilitation facility serving young people with physical disabilities. Specifically, the areas of practice addressed are screening and assessment. The process started in 1987 with an identification of the need to find a holistic framework that meets the complex needs of clients with chronic physical disabilities. The conceptual model of occupational performance, as outlined in the Guidelines, provided such a framework. The process of incorporating the Guidelines into the screening and assessment practices of occupational therapists at Erinoak Serving Young People With Physical Disabilities is described, with examples of documents developed by the department. Suggestions are given to integrate the conceptual model of occupational performance into the practice of occupational therapists working with children and adolescents with physical disabilities.

Delfryn House is a 28 bedded specialist residential intensive rehabilitation facility situated on the outskirts of Mold in North Wales.