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Gauthier C, Walden K, Jervis-Rademeyer H, Musselman KE, Kaiser A, Wolfe DL, Noonan VK, Donkers SJ. Technology used in activity based therapy for individuals living with spinal cord injury across Canada. Spinal Cord Ser Cases 2023; 9:1. [PMID: 36646680 PMCID: PMC9842763 DOI: 10.1038/s41394-022-00558-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 12/05/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
STUDY DESIGN Cross-sectional equipment inventory. OBJECTIVES The objective of this study was to describe the equipment used in activity-based therapy (ABT) programs for individuals with spinal cord injury or disorder (SCI/D) across Canada. SETTINGS Publicly funded and private SCI/D care settings. METHODS A survey on equipment available for ABT for different therapeutic goals was answered by Canadian sites providing SCI/D rehabilitation. Information about the setting and type of client were also collected. The survey results were compiled into an inventory of the reported types and use of ABT related equipment, with equipment grouped into varying levels of technology. Descriptive statistics and qualitative descriptive analysis were used to answer the questions: (1) 'who' used the equipment, (2) 'what' types of equipment are used, (3) 'why' (i.e., for which therapeutic goals), and (4) 'how' it is used. RESULTS Twenty-two sites from eight Canadian provinces completed the survey. Reported equipment was classified into 5 categories (from low to high-tech). Most equipment reported was used to train balance. The high-tech equipment reported as available, was mostly used for walking training and strengthening of the lower limbs. Low-tech equipment was reported as being used most frequently, while high-tech devices, although available, were reported as infrequently or rarely used. CONCLUSIONS A large spectrum of equipment with varying levels of technology were reported as available, but were inconsistently used to provide ABT interventions across sites. In order to increase the clinical use of available equipment for ABT, education tools such as protocols regarding ABT principles and implementation are needed.
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Affiliation(s)
- Cindy Gauthier
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada
| | | | - Hope Jervis-Rademeyer
- KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anita Kaiser
- KITE, Toronto Rehabilitation Institute -University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dalton L Wolfe
- Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Sarah J Donkers
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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2
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Hou W, Qin S, Thompson CH. Effective Response to Hospital Congestion Scenarios: Simulation-Based Evaluation of Decongestion Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16348. [PMID: 36498419 PMCID: PMC9737001 DOI: 10.3390/ijerph192316348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Hospital overcrowding is becoming a major concern in the modern era due to the increasing demand for hospital services. This study seeks to identify effective and efficient ways to resolve the serious problem of congestion in hospitals by testing a range of decongestion strategies with simulated scenarios. In order to determine more efficient solutions, interventions with smaller changes were consistently tested at the beginning through a simulation platform. In addition, the implementation patterns were investigated, which are important to hospital managers with respect to the decisions made to control hospital congestion. The results indicated that diverting a small number of ambulances seems to be more effective and efficient in congestion reduction compared to other approaches. Furthermore, instead of implementing an isolated approach continuously, combining one approach with other strategies is recommended as a method for dealing with hospital overcrowding.
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Affiliation(s)
- Wanxin Hou
- School of Information Science and Technology, Research Centre for Intelligent Information Technology, Nantong University, Nantong 226019, China
| | - Shaowen Qin
- College of Science and Engineering, Flinders University, Adelaide 5042, Australia
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3
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Abstract
OBJECTIVE Our objective was to assess how, and to what extent, a systems-level perspective is considered in decision-making processes for health interventions by illustrating how studies define the boundaries of the system in their analyses and by defining the decision-making context in which a systems-level perspective is undertaken. METHOD We conducted a scoping review following the Joanna Briggs Institute methodology. MEDLINE, EMBASE, Cochrane Library, and EconLit were searched and key search concepts included decision making, system, and integration. Studies were classified according to an interpretation of the "system" of analysis used in each study based on a four-level model of the health system (patient, care team, organization, and/or policy environment) and using categories (based on intervention type and system impacts considered) to describe the decision-making context. RESULTS A total of 2,664 articles were identified and 29 were included for analysis. Most studies (16/29; 55%) considered multiple levels of the health system (i.e., patient, care team, organization, environment) in their analysis and assessed multiple classes of interventions versus a single class of intervention (e.g., pharmaceuticals, screening programs). Approximately half (15/29; 52%) of the studies assessed the influence of policy options on the system as a whole, and the other half assessed the impact of interventions on other phases of the disease pathway or life trajectory (14/29; 48%). CONCLUSIONS We found that systems thinking is not common in areas where health technology assessments (HTAs) are typically conducted. Against this background, our study demonstrates the need for future conceptualizations and interpretations of systems thinking in HTA.
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A framework for in situ molecular characterization of coral holobionts using nanopore sequencing. Sci Rep 2020; 10:15893. [PMID: 32985530 PMCID: PMC7522235 DOI: 10.1038/s41598-020-72589-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/03/2020] [Indexed: 01/21/2023] Open
Abstract
Molecular characterization of the coral host and the microbial assemblages associated with it (referred to as the coral holobiont) is currently undertaken via marker gene sequencing. This requires bulky instruments and controlled laboratory conditions which are impractical for environmental experiments in remote areas. Recent advances in sequencing technologies now permit rapid sequencing in the field; however, development of specific protocols and pipelines for the effective processing of complex microbial systems are currently lacking. Here, we used a combination of 3 marker genes targeting the coral animal host, its symbiotic alga, and the associated bacterial microbiome to characterize 60 coral colonies collected and processed in situ, during the Tara Pacific expedition. We used Oxford Nanopore Technologies to sequence marker gene amplicons and developed bioinformatics pipelines to analyze nanopore reads on a laptop, obtaining results in less than 24 h. Reef scale network analysis of coral-associated bacteria reveals broadly distributed taxa, as well as host-specific associations. Protocols and tools used in this work may be applicable for rapid coral holobiont surveys, immediate adaptation of sampling strategy in the field, and to make informed and timely decisions in the context of the current challenges affecting coral reefs worldwide.
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Saadouli H, Ltaif A. Evaluating the impact of human resource management on the patient flow at an outpatient orthopedic clinic. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1788335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Hadhemi Saadouli
- College of Business and Economics, Qassim University, Buraydah, Saudi Arabia
- Laboratory MODILS, Faculty of Economics and Management Sciences, University of Sfax, Sfax, Tunisia
| | - Abdelmoneem Ltaif
- Laboratory MODILS, Faculty of Economics and Management Sciences, University of Sfax, Sfax, Tunisia
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Evaluation of a Clinical Protocol to Assess and Diagnose Neuropathic Pain During Acute Hospital Admission: Results From Traumatic Spinal Cord Injury. Clin J Pain 2019; 34:104-112. [PMID: 28609308 PMCID: PMC5768215 DOI: 10.1097/ajp.0000000000000523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A clinical protocol was developed for clinicians to routinely assess and initiate treatment for patients with neuropathic pain (NP) in an acute care setting. The objectives of this study were to: (1) determine the incidence and onset of NP in patients with traumatic spinal cord injury during acute care and (2) describe how the implementation of a clinical protocol impacts the assessment and diagnosis of NP. MATERIALS AND METHODS The study was a cohort analysis with a pre-post-test utilizing a historical control. Data were retrospectively collected from a patient registry and charts. Participants were randomly selected in cohort 1 (control) and cohort 2 (NP clinical protocol). RESULTS The incidence of NP was 56% without significant difference between the cohorts (P=0.3). Onset of NP was 8 days (SD=14) across the study and >85% of the participants with NP were diagnosed within 2 weeks. Participants with incomplete injuries had a significant earlier onset than participants with complete injuries (6.2±12.8, 10.9±15.8 d; P=0.003). The mean number of days from hospital admission to initial assessment decreased with use of the NP clinical protocol (3.7±5.7 d; P=0.02). DISCUSSION This study demonstrates a high incidence and early onset of NP in traumatic spinal cord injury during acute hospital care, with an earlier emergence in participants with incomplete injury. The NP clinical protocol ensured continuous assessment and documentation of NP while decreasing the time to an initial screen, but did not impact diagnosis.
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Zhang X. Application of discrete event simulation in health care: a systematic review. BMC Health Serv Res 2018; 18:687. [PMID: 30180848 PMCID: PMC6123911 DOI: 10.1186/s12913-018-3456-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/08/2018] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The objective was to explore the current advances and extent of DES (Discrete Event Simulation) applied to assisting with health decision making, as well as to categorize the wide spectrum of health-related topics where DES was applied. METHODS A systematic review was conducted of the literature published over the last two decades. Original research articles were included and reviewed if they concentrated on the topic of DES technique applied to health care management with model frameworks explicitly demonstrated. No restriction regarding the settings of DES application was applied. RESULTS A total of 211 papers met the predefined inclusion criteria. The number of publications included increased significantly especially after 2010.101 papers (48%) stated explicitly disease areas targeted, the most frequently modeled of which are related to circulatory system, nervous system and Neoplasm. The DES applications were distributed unevenly into 4 major classes: health and care systems operation (HCSO) (65%), disease progression modeling (DPM) (28%), screening modeling (SM) (5%) and health behavior modeling (HBM) (2%). More than 68% of HCSO by DES were focused on specific problems in individual units. However, more attempts at modeling highly integrated health service systems as well as some new trends were identified. CONCLUSIONS DES technique has been an effective tool to approach a wide variety of health care issues. Among all DES applications in health care, health system operations research occupied the most considerable proportion and increased most significantly. Health Economic Evaluation (HEE) was the second most common topic for DES in health care, but with stable rather than increasing numbers of publications.
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Affiliation(s)
- Xiange Zhang
- Department of Health Care Management, Institute of Public Health and Nursing Research, Health sciences, University of Bremen, Grazer Str. 2a, 28359, Bremen, Germany.
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8
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Fehlings MG, Noonan VK, Atkins D, Burns AS, Cheng CL, Singh A, Dvorak MF. Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury. J Neurotrauma 2018; 34:2841-2842. [PMID: 28056628 PMCID: PMC5653145 DOI: 10.1089/neu.2016.4926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI) is a devastating event causing lifelong disability that results in a significant decrease in quality of life and immense cost to the health care system, individuals and their families. Providing specialized and timely care can improve recovery and reduce costs, but to make this a reality requires understanding of the current care delivery processes and the care journey. The objective of this focus issue is to examine the current state of health care delivery and discover opportunities to improve access and timing to specialized care for individuals with tSCI. This issue provides an overview of care throughout the SCI continuum and its impact on individuals with tSCI using pan-Canadian data. The issue also presents findings from the RHI Access to Care and Timing (ACT) Project, a multi-center research study involving a multi-disciplinary team of Canadian researchers and clinicians. The initial articles describe the current state of the tSCI care journey including a comparison of environmental barriers, health status, and quality-of-life outcomes between patients living in rural and urban settings. The issue concludes with an article describing the national knowledge translation efforts of using the evidence from the articles published here to inform practice and policy change. Overall, this focus issue will be an excellent reference to guide and optimize evidence informed decision-making in the care of those with tSCI. The evidence can be transferred to care in non-traumatic SCI and other conditions that benefit from timely access to specialized care such as stroke and traumatic brain injury.
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Affiliation(s)
- Michael G Fehlings
- 1 Department of Surgery, University of Toronto , Toronto, Ontario, Canada
| | | | - Derek Atkins
- 3 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Anthony S Burns
- 4 Division of Physiatry, Department of Medicine, University of Toronto , Toronto, Ontario, Canada
| | | | - Anoushka Singh
- 5 SCI Clinical Research Unit, Toronto Western Hospital , Toronto, Ontario, Canada
| | - Marcel F Dvorak
- 6 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
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9
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Thompson C, Feldman DE, Mac-Thiong JM. Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center. J Spinal Cord Med 2018; 41:142-148. [PMID: 27077578 PMCID: PMC5901449 DOI: 10.1080/10790268.2016.1165448] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
CONTEXT/OBJECTIVE Early surgery in individuals with traumatic spinal cord injury (T-SCI) can improve neurological recovery and reduce complications, costs and hospitalization. Patient-related and healthcare-related factors could influence surgical delay. This study aimed at determining factors contributing to surgical delay in individuals with T-SCI. DESIGN Prospective cohort study. SETTING Single Level I trauma center in Québec, Canada. PARTICIPANTS One hundred and forty-four patients who sustained a T-SCI. INTERVENTIONS None. OUTCOME MEASURES Socio-demographic and clinical administrative data were collected during the pre-operative period. The cohort was stratified in early surgery, or ES (<24 hours post-trauma) and late surgery, or LS (≥ 24 hours post-trauma) groups. A multivariate logistic regression analysis using patient- and healthcare-related factors was carried out to identify the main predictors of LS. RESULTS 93 patients had ES (15.6 ± 4.7 hours post-trauma), which is 31 hours earlier than the 51 patients in the LS group (46.9 ± 30.9 hours; P < 10-3). The transfer delay from trauma site to the SCI center was 8 hours shorter (5.0 ± 3.0 hours vs 13.6 ± 17.0; P < 10-3) for the ES group, and the surgical plan was completed 17 hours faster (6.0 ± 4.0 hours vs 23.3 ± 23.6 hours; P < 10-3) than for the LS group. The occurrence of LS was predicted by modifiable factors, such as the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room. CONCLUSIONS A dedicated team for surgical treatment of individuals with T-SCI, involving direct transfer to the SCI center, faster surgery planning and access to the operating room in hospitals dealing with emergencies from all subspecialties could improve surgical delay and increase the rate of patients undergoing ES.
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Affiliation(s)
- Cynthia Thompson
- Research Center, Hôpital Sacré-Cœur de Montréal, Montréal, Québec, Canada,Correspondence to: Cynthia Thompson, Research Center, Hôpital Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréal, Québec, Canada, H4J 1C5. E-mail:
| | - Debbie E. Feldman
- School of Rehabilitation, University of Montréal, Montréal, Québec, Canada
| | - Jean-Marc Mac-Thiong
- Research Center, Hôpital Sacré-Cœur de Montréal, Montréal, Québec, Canada,Department of Surgery, Université de Montréal, Montréal, Québec, Canada,Department of Surgery, Hôpital Ste-Justine, Montréal, Québec, Canada
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10
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Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O'Connell C, Linassi AG, Ho C, Short C, Ethans K, Charbonneau R, Paquet J, Noonan VK. Does Specialized Inpatient Rehabilitation Affect Whether or Not People with Traumatic Spinal Cord Injury Return Home? J Neurotrauma 2017; 34:2867-2876. [DOI: 10.1089/neu.2016.4930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Tova Plashkes
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Tian Shen
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | - Colleen O'Connell
- Physical Medicine and Rehabilitation, Dalhousie University, Fredericton, New Brunswick, Canada
| | - A. Gary Linassi
- Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Christine Short
- Department of Medicine, Dalhousie University, Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Charbonneau
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jérôme Paquet
- Neurosurgery, CHU de Québec; Department of Surgery, Université Laval, Québec, Canada
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Fehlings MG, Cheng CL, Chan E, Thorogood NP, Noonan VK, Ahn H, Bailey CS, Singh A, Dvorak MF. Using Evidence To Inform Practice and Policy To Enhance the Quality of Care for Persons with Traumatic Spinal Cord Injury. J Neurotrauma 2017; 34:2934-2940. [PMID: 28566019 PMCID: PMC5652974 DOI: 10.1089/neu.2016.4938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In today's economic climate, there is a need to demonstrate a return on investment for healthcare spending and for clinical practice and policy to be informed by evidence. Navigating this process is difficult for decision-makers, clinicians, and researchers alike. This article will describe how a knowledge translation framework and an evidence-based policy-making process were integrated to clarify the problem, frame options, and plan implementation, to impact clinical practice and policy in the area of traumatic spinal cord injury (tSCI). The Access to Care and Timing (ACT) project is focused on optimizing the access and timing of specialized healthcare delivery for persons sustaining a tSCI in Canada. A simulation model was developed that uses current patient data to address complex problems faced by the healthcare system. At a workshop, participants stressed the importance of linking interventions to short- and long-term outcomes to drive change. Presently, there are no national, system level indicators to monitor performance after tSCI. Although the ideal system of care after tSCI is unknown, indicator collection will establish a baseline to measure improvement. The workshop participants prioritized two indicators important from the clinician and patient perspective-timely admission to rehabilitation and meaningful community participation. The ACT simulation model for tSCI care will be used to promote the uptake of identified indicators and provide a predictive link between interventions on potential outcomes. The standardized collection of outcome-oriented indicators will help to evaluate the access and timing of care and to define the ideal system of care after SCI.
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Affiliation(s)
| | | | - Elaine Chan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | | | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Christopher S. Bailey
- Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Anoushka Singh
- SCI Clinical Research Unit, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Glennie RA, Batke J, Fallah N, Cheng CL, Rivers CS, Noonan VK, Dvorak MF, Fisher CG, Kwon BK, Street JT. Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes. J Neurotrauma 2017; 34:2877-2882. [PMID: 28462633 PMCID: PMC5653139 DOI: 10.1089/neu.2016.4931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
There is worldwide geographic variation in the epidemiology of traumatic spinal cord injury (tSCI). The aim of this study was to determine whether environmental barriers, health status, and quality-of-life outcomes differ between patients with tSCI living in rural or urban settings, and whether patients move from rural to urban settings after tSCI. A cohort review of the Rick Hansen SCI Registry (RHSCIR) was undertaken from 2004 to 2012 for one province in Canada. Rural/urban setting was determined using postal codes. Outcomes data at 1 year in the community included the Short Form-36 Version 2 (SF36v2™), Life Satisfaction Questionnaire, Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Functional Independent Measure® Instrument, and SCI Health Questionnaire. Statistical methodologies used were t test, Mann-Whitney U test, and Fisher's exact or χ2 test. In the analysis, 338 RHSCIR participants were included; 65 lived in a rural setting and 273 in an urban setting. Of the original patients residing in a rural area at discharge,10 moved to an urban area by 1 year. Those who moved from a rural to urban area reported a lower SF-36v2™ Mental Component Score (MCS; p = 0.04) and a higher incidence of depression at 1 year (p = 0.04). Urban patients also reported a higher incidence of depression (p = 0.02) and a lower CHIEF-SF total score (p = 0.01) indicating fewer environmental barriers. No significant differences were found in other outcomes. Results suggest that although the patient outcomes are similar, some patients move from rural to urban settings after tSCI. Future efforts should target screening mental health problems early, especially in urban settings.
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Affiliation(s)
- R. Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Juliet Batke
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | | | | | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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13
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White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study. J Neurotrauma 2017; 34:2892-2900. [DOI: 10.1089/neu.2016.4934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nicolas Dea
- Service de Neurochirurgie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Najmedden Attabib
- Dalhousie University, Halifax, Nova Scotia; Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Ahn H, Lewis R, Santos A, Cheng CL, Noonan VK, Dvorak MF, Singh A, Linassi AG, Christie S, Goytan M, Atkins D. Forecasting Financial Resources for Future Traumatic Spinal Cord Injury Care Using Simulation Modeling. J Neurotrauma 2017; 34:2917-2923. [PMID: 28594315 PMCID: PMC5653147 DOI: 10.1089/neu.2016.4936] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Survivors of traumatic spinal cord injury (tSCI) have intense healthcare needs during acute and rehabilitation care and often through the rest of life. To prepare for a growing and aging population, simulation modeling was used to forecast the change in healthcare financial resources and long-term patient outcomes between 2012 and 2032. The model was developed with data from acute and rehabilitation care facilities across Canada participating in the Access to Care and Timing project. Future population and tSCI incidence for 2012 and 2032 were predicted with data from Statistics Canada and the Canadian Institute for Health Information. The projected tSCI incidence for 2012 was validated with actual data from the Rick Hansen SCI Registry of the participating facilities. Using a medium growth scenario, in 2032, the projected median age of persons with tSCI is 57 and persons 61 and older will account for 46% of injuries. Admissions to acute and rehabilitation facilities in 2032 were projected to increase by 31% and 25%, respectively. Because of the demographic shift to an older population, an increase in total population life expectancy with tSCI of 13% was observed despite a 22% increase in total life years lost to tSCI between 2012 and 2032. Care cost increased 54%, and rest of life cost increased 37% in 2032, translating to an additional CAD $16.4 million. With the demographics and management of tSCI changing with an aging population, accurate projections for the increased demand on resources will be critical for decision makers when planning the delivery of healthcare after tSCI.
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Affiliation(s)
- Henry Ahn
- 1 University of Toronto Spine Program , Toronto, Ontario, Canada
| | - Rachel Lewis
- 2 Centre for Operations Excellence, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Argelio Santos
- 3 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | | | - Marcel F Dvorak
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Anoushka Singh
- 5 SCI Clinical Research Unit, Toronto Western Hospital , Toronto, Ontario, Canada
| | - A Gary Linassi
- 6 Department of Physical Medicine and Rehabilitation, University of Saskatchewan , Saskatoon, Saskatchewan, Canada
| | - Sean Christie
- 7 Research Division of Neurosurgery, Dalhousie University , Halifax, Nova Scotia, Canada
| | - Michael Goytan
- 8 Sections of Orthopedics and Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Derek Atkins
- 9 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
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Dvorak MF, Cheng CL, Fallah N, Santos A, Atkins D, Humphreys S, Rivers CS, White BA, Ho C, Ahn H, Kwon BK, Christie S, Noonan VK. Spinal Cord Injury Clinical Registries: Improving Care across the SCI Care Continuum by Identifying Knowledge Gaps. J Neurotrauma 2017; 34:2924-2933. [PMID: 28745934 PMCID: PMC5653140 DOI: 10.1089/neu.2016.4937] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Timely access and ongoing delivery of care and therapeutic interventions is needed to maximize recovery and function after traumatic spinal cord injury (tSCI). To ensure these decisions are evidence-based, access to consistent, reliable, and valid sources of clinical data is required. The Access to Care and Timing Model used data from the Rick Hansen SCI Registry (RHSCIR) to generate a simulation of healthcare delivery for persons after tSCI and to test scenarios aimed at improving outcomes and reducing the economic burden of SCI. Through model development, we identified knowledge gaps and challenges in the literature and current health outcomes data collection throughout the continuum of SCI care. The objectives of this article were to describe these gaps and to provide recommendations for bridging them. Accurate information on injury severity after tSCI was hindered by difficulties in conducting neurological assessments and classifications of SCI (e.g., timing), variations in reporting, and the lack of a validated SCI-specific measure of associated injuries. There was also limited availability of reliable data on patient factors such as multi-morbidity and patient-reported measures. Knowledge gaps related to structures (e.g., protocols) and processes (e.g., costs) at each phase of care have prevented comprehensive evaluation of system performance. Addressing these knowledge gaps will enhance comparative and cost-effectiveness evaluations to inform decision-making and standards of care. Recommendations to do so were: standardize data element collection and facilitate database linkages, validate and adopt more outcome measures for SCI, and increase opportunities for collaborations with stakeholders from diverse backgrounds.
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Affiliation(s)
- Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Argelio Santos
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Derek Atkins
- Operations and Logistics Division, Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Christie
- Research Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
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16
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Marion TE, Rivers CS, Kurban D, Cheng CL, Fallah N, Batke J, Dvorak MF, Fisher CG, Kwon BK, Noonan VK, Street JT. Previously Identified Common Post-Injury Adverse Events in Traumatic Spinal Cord Injury-Validation of Existing Literature and Relation to Selected Potentially Modifiable Comorbidities: A Prospective Canadian Cohort Study. J Neurotrauma 2017; 34:2883-2891. [PMID: 28562167 PMCID: PMC5653096 DOI: 10.1089/neu.2016.4933] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Adverse events (AEs) are common during care in patients with traumatic spinal cord injury (tSCI). Increased risk of AEs is linked to patient factors including pre-existing comorbidities. Our aim was to examine the relationships between patient factors and common post-injury AEs, and identify potentially modifiable comorbidities. Adults with tSCI admitted to a Level I acute specialized spine center between 2006 and 2014 who were enrolled in the Rick Hansen SCI Registry (RHSCIR) and had AE data collected using the Spine Adverse Events Severity system were included. Patient demographic, neurological injury, and comorbidities data were obtained from RHSCIR. Potentially modifiable comorbidities were grouped into health-related conditions, substance use/withdrawal, and psychiatric conditions. Negative binomial regression and multiple logistic regression were used to model the impact of patient factors on the number of AEs experienced and the occurrence of the five previously identified common AEs, respectively. Of the 444 patients included in the study, 24.8% reported a health-related condition, 15.3% had a substance use/withdrawal condition, 8% reported having a psychiatric condition; and 79.3% experienced one or more AEs. Older age (p = 0.004) and more severe injuries (p < 0.001) were nonmodifiable independent variables significantly associated with increased AEs. The AEs experienced by patients were urinary tract infections (42.8%), pneumonia (39.2%), neuropathic pain (31.5%), delirium (18.2%), and pressure ulcers (11.0%). Risk of delirium increased in those with substance use/withdrawal; and pneumonia risk increased with psychiatric comorbidities. Opportunity exists to develop clinical algorithms that include these types of risk factors to reduce the incidence and impact of AEs.
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Affiliation(s)
- Travis E Marion
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Carly S Rivers
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Dilnur Kurban
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | - Nader Fallah
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Juliet Batke
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Charles G Fisher
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | - Brian K Kwon
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
| | | | - John T Street
- 1 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Vancouver, British Columbia, Canada
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17
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Truchon C, Fallah N, Santos A, Vachon J, Noonan VK, Cheng CL. Impact of Therapy on Recovery during Rehabilitation in Patients with Traumatic Spinal Cord Injury. J Neurotrauma 2017; 34:2901-2909. [PMID: 28493787 PMCID: PMC5652980 DOI: 10.1089/neu.2016.4932] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Evidence-based planning of rehabilitation interventions is important to improving cost efficiency while maintaining patient and system outcomes. This article aims to explore the relationship between rehabilitation therapy, functional outcome, bed utilization, and care costs after traumatic spinal cord injury (tSCI). A retrospective review of 262 persons with tSCI admitted to an inpatient rehabilitation facility from 2005–2012 was conducted. Treatment variables and outcome measures included rehabilitation length of stay (LOS), days to rehabilitation (onset), hours and intensity of therapy, and Functional Independence Measure (FIM). Polynomial regression models and generalized additive models were applied to explore the relationship between therapy hours and motor FIM change. Simulation modeling was used to assess the impact of hypothetically increasing therapy intensity. Patients were grouped by injury as: C1–4 American Spinal Injury Association (ASIA) Impairment Scale (AIS) A,B,C; C5–8 AIS A,B,C; T1–S5 AIS A,B,C; and AIS D. The sample was 85% male, mean age 45.9, median LOS 102 days, and mean therapy intensity 5.7 h/week. Motor FIM change was positively associated with total hours of therapy (β = 0.40, p < 0.0001) up to a certain time point, adjusted for age, gender, injury, complications, and rehabilitation onset. Hypothetically increasing therapy intensity by 50% and 100% resulted in average motor FIM efficiency gain ranging between 0.04–0.07 and 0.1–0.17, respectively, across injury groups. The hypothetical changes resulted in reductions in the average LOS and bed utilization rate, translating to cost savings of $20,000 and $50,000 (2011 CAD) for the +50% and +100% scenarios, respectively. The results highlight the importance of monitoring functional change throughout rehabilitation after tSCI and the need for customized therapeutic strategies.
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Affiliation(s)
- Catherine Truchon
- Institut national d'excellence en santé et en services sociaux, Québec City, Québec, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Argelio Santos
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Joëlle Vachon
- Institut de réadaptation en déficience physique de Québec, Québec City, Québec, Canada
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18
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Cheng CL, Noonan VK, Shurgold J, Chen J, Rivers CS, Khaleghi Hamedani H, Humphreys S, Bailey CS, Attabib N, Mac Thiong JM, Goytan M, Paquet J, Fox R, Ahn H, Kwon BK, Fourney DR. Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern. J Neurotrauma 2017; 34:2856-2866. [PMID: 28325105 PMCID: PMC5652977 DOI: 10.1089/neu.2016.4929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Current research indicates that more than half of patients with traumatic spinal cord injury (tSCI) experience delays in transfer and receive surgery >24 h post-injury. The objectives of this study were to determine the geographic distribution of tSCI in Canada relative to specialized treatment facilities, to assess clinical and logistical factors at play for indirect admissions to those facilities, and to explore differences in current time to admission and simulated scenarios in an attempt to assess the potential impact of changes to triage protocols. This study included data from 876 patients with tSCI enrolled in the prospectively collected acute Rick Hansen Spinal Cord Injury Registry (RHSCIR) between January 1, 2010 and December 31, 2013 for whom there were data on the location of their injury. Patients transported directly to a RHSCIR acute facility were more likely to reach the facility within 1 h of injury, whereas those transported indirectly were more likely to arrive 7 h later. Considering the injuries occurring within 40 km of a RHSCIR acute facility (n = 323), 249 patients (77%) were directly and 74 (23%) were indirectly admitted. In the multivariate regression analysis, only older age and longer road distance remained significantly associated with being indirectly admitted to a RHSCIR facility. Compared with the current status, the median time to admission decreased by 20% (3.5 h) in the 100% direct admission scenario, and increased by 102% (8.9 h) in the 100% indirect admission scenario.
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Affiliation(s)
| | | | | | - Jason Chen
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Carly S Rivers
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | | | - Christopher S Bailey
- Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Najmedden Attabib
- Horizon Health Network, Dalhousie University, Saint John, New Brunswick, Canada
| | - Jean-Marc Mac Thiong
- Department of Surgery, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Michael Goytan
- Sections of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerome Paquet
- Sciences Neurologiques, Université Laval, Québec, Quebec, Canada
| | - Richard Fox
- Faculty of Medicine and Dentistry, Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daryl R Fourney
- Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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Santos A, Fallah N, Lewis R, Dvorak MF, Fehlings MG, Burns AS, Noonan VK, Cheng CL, Chan E, Singh A, Bélanger L, Atkins D. Methodology of the Access to Care and Timing Simulation Model for Traumatic Spinal Cord Injury Care. J Neurotrauma 2017; 34:2843-2847. [PMID: 28285549 PMCID: PMC5652975 DOI: 10.1089/neu.2016.4927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite the relatively low incidence of traumatic spinal cord injury (tSCI), the management and care of persons with tSCI can be resource intensive and complex, spanning multiple phases of care and disciplines. Using a simulation model built with a system level view of the healthcare system allows for prediction of the impact of interventions on patient and system outcomes from injury through to community reintegration after tSCI. As has been previously described, the Access to Care and Timing (ACT) project developed a simulation model for tSCI care using techniques from operations research. The objective of this article is to briefly describe the methodology and the application of the ACT Model, as it was used in several of the articles in this focus issue. The approaches employed in this model provide a framework to look into the complexity of interactions both within and among the different SCI programs, sites, and phases of care.
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Affiliation(s)
- Argelio Santos
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Rachel Lewis
- Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Anthony S Burns
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Elaine Chan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Anoushka Singh
- SCI Clinical Research Unit, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Lise Bélanger
- Acute Spine Unit, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Derek Atkins
- Sauder School of Business, University of British Columbia, Vancouver, British Columbia, Canada
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Burns AS, Santos A, Cheng CL, Chan E, Fallah N, Atkins D, Dvorak MF, Ho C, Ahn H, Paquet J, Kwon BK, Noonan VK. Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project. J Neurotrauma 2017; 34:2910-2916. [PMID: 28245734 PMCID: PMC5653133 DOI: 10.1089/neu.2016.4935] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Costs associated with initial hospitalization following spinal cord injury (SCI) are substantial, and a major driver of costs is the length of stay (LOS); that is, the time that the injured individual remains hospitalized prior to community reintegration. Our aim was to study the factors and variables that contribute to LOS following traumatic SCI. Modeling (process mapping of the SCI healthcare delivery system in Canada and discrete event simulation) and regression analysis using a national registry of individuals with acute traumatic SCI in Canada, existing databases, and peer-reviewed literature were used to examine the driver of LOS following traumatic SCI. In different jurisdictions, there is considerable variation in the definitions and methods used to determine LOS following SCI. System LOS can be subdivided into subcomponents, and progression through these is not unidirectional. Modeling reveals that healthcare organization and processes are important contributors to differences in LOS independent of patient demographics and injury characteristics. Future research is required to identify and improve understanding of contributors to LOS following traumatic SCI. This will help enhance system performance. Work in this area will be facilitated by the adoption of common terminology and definitions, as well as by the use of simulations and modeling.
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Affiliation(s)
- Anthony S Burns
- 1 Division of Physiatry, Department of Medicine, University of Toronto , Toronto Ontario, Canada
| | - Argelio Santos
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | - Elaine Chan
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Nader Fallah
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Derek Atkins
- 3 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Chester Ho
- 5 Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Henry Ahn
- 6 University of Toronto Spine Program , Toronto, Ontario, Canada
| | | | - Brian K Kwon
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
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Liu W, Shang FF, Xu Y, Belegu V, Xia L, Zhao W, Liu R, Wang W, Liu J, Li CY, Wang TH. eIF5A1/RhoGDIα pathway: a novel therapeutic target for treatment of spinal cord injury identified by a proteomics approach. Sci Rep 2015; 5:16911. [PMID: 26593060 PMCID: PMC4655360 DOI: 10.1038/srep16911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/22/2015] [Indexed: 02/05/2023] Open
Abstract
Spinal cord injury (SCI) is frequently accompanied by a degree of spontaneous functional recovery. The underlying mechanisms through which such recovery is generated remain elusive. In this study, we observed a significant spontaneous motor function recovery 14 to 28 days after spinal cord transection (SCT) in rats. Using a comparative proteomics approach, caudal to the injury, we detected difference in 20 proteins. Two of these proteins, are eukaryotic translation initiation factor 5A1 (eIF5A1) that is involved in cell survival and proliferation, and Rho GDP dissociation inhibitor alpha (RhoGDIα), a member of Rho GDI family that is involved in cytoskeletal reorganization. After confirming the changes in expression levels of these two proteins following SCT, we showed that in vivo eIF5A1 up-regulation and down-regulation significantly increased and decreased, respectively, motor function recovery. In vitro, eIF5A1 overexpression in primary neurons increased cell survival and elongated neurite length while eIF5A1 knockdown reversed these results. We found that RhoGDIα up-regulation and down-regulation rescues the effect of eIF5A1 down-regulation and up-regulation both in vivo and in vitro. Therefore, we have identified eIF5A1/RhoGDIα pathway as a new therapeutic target for treatment of spinal cord injured patients.
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Affiliation(s)
- Wei Liu
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Fei-Fei Shang
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Yang Xu
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Visar Belegu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lei Xia
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Wei Zhao
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Ran Liu
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Wei Wang
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Jin Liu
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
| | - Chen-Yun Li
- Key Laboratory of Agro-Biodiversity and Pest Management of Education Ministry of China, Yunnan Agricultural University, Kunming, 650000, P.R. China
| | - Ting-Hua Wang
- Institute of Neurological Disease, The state key laboratory of Biotherapy, Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 61041, P.R. China
- Institute of Neuroscience, Kunming medical University, Kunming 650031, P.R. China
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Kornhaber R, Wiechula R, McLean L. The effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513080-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Reliability of the spine adverse events severity system (SAVES) for individuals with traumatic spinal cord injury. Spinal Cord 2014; 52:758-63. [DOI: 10.1038/sc.2014.116] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 06/06/2014] [Indexed: 11/08/2022]
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Noreau L, Noonan VK, Cobb J, Leblond J, Dumont FS. Spinal Cord Injury Community Survey: Understanding the Needs of Canadians with SCI. Top Spinal Cord Inj Rehabil 2014; 20:265-76. [PMID: 25477740 PMCID: PMC4252127 DOI: 10.1310/sci2004-265] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a lack of literature regarding service needs of people with SCI living in the community. Better assessment of expressed and met and unmet needs would help in the development of effective service delivery. OBJECTIVE From a national SCI Community Survey in Canada, the aim was to identify the most critical service needs of people living in the community at least 1 year post discharge from rehabilitation and the support they received to meet their needs. METHOD Data were collected mainly through a secure Web site and encompassed demographics, personal and household income, an SCI severity measure, and an SCI community needs measure containing information on 13 SCI-related needs. RESULTS A total of 1,549 persons with SCI (traumatic lesion, n = 1,137; nontraumatic lesion, n = 412) across Canada completed the survey. Most critical needs for community integration were expressed by a substantial proportion of survey participants, but significantly more expressed and met needs were reported by persons with a traumatic than a nontraumatic lesion. Personal and environmental characteristics influenced the probability of expressing and meeting needs (eg, severity of injury and household income). Help and support to meet expressed needs were received from government agencies, community organizations, and friends or family. CONCLUSION Better assessment of expressed and met or unmet needs for services remains a challenge but will serve as a tool to optimize service delivery in the community. Environmental barriers to services, particularly the process of getting needs met and associated costs, remain an issue that requires a reconsideration of some aspects of access to services.
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Affiliation(s)
- Luc Noreau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval, Quebec City, Canada
| | - Vanessa K. Noonan
- Rick Hansen Institute, Vancouver, Canada
- Division of Spine, Department of Orthopedics, University of British Columbia, Vancouver, Canada
| | - John Cobb
- Rick Hansen Institute, Vancouver, Canada
- Vancouver General Hospital, Vancouver, Canada
| | - Jean Leblond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval, Quebec City, Canada
| | - Frédéric S. Dumont
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) and Université Laval, Quebec City, Canada
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