1
|
Bray EA, Hogan C, Mitchell J, Geraghty T, Ownsworth T. Impact of Early Personal Resources on Long-Term Psychosocial Outcomes After Moderate-to-Severe Traumatic Brain Injury: A Systematic Review. J Head Trauma Rehabil 2024:00001199-990000000-00157. [PMID: 38758101 DOI: 10.1097/htr.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To investigate the relationship between preinjury or early personal resources and long-term psychosocial outcomes following moderate-to-severe traumatic brain injury (TBI) and examine evidence for the stability of personal resources over time. METHODS The review protocol was registered with the International Register of Systematic Reviews (PROSPERO, Registration No. CRD4202341056). A search of PsycINFO, Cumulative Index to Allied Health Literature (CINAHL), MEDLINE, Scopus, and Web of Science was conducted from inception to February 23, 2023, for longitudinal studies involving adults with moderate-to-severe TBI that examined: (1) the relationship between preinjury or early personal resources (measured ≤6 months postinjury) and later psychosocial outcomes or (2) stability of personal resources over time with a minimum reassessment interval of 3 months. Two reviewers independently assessed eligibility and rated methodological quality of studies using a checklist informed by Strengthening the Reporting of Observational Studies in Epidemiology. RESULTS A narrative synthesis was conducted on 14 eligible articles summarizing 12 studies (N = 826). Nine studies examined the impact of preinjury or early personal resources on long-term psychosocial outcomes, most typically at 12 months postdischarge. Out of 9 studies 7 indicated that self-reported preinjury or early personal resources, including productive coping, higher self-esteem and resilience, and lower neuroticism, were associated with better psychosocial outcomes. Evidence from 7 studies examining the stability of personal resources over time was generally mixed, with personality changes (eg, neuroticism, conscientiousness, and extraversion) more evident from informant ratings than self-ratings. CONCLUSION Preinjury or early personal resources may influence later psychosocial outcomes after TBI. Further research is needed to investigate the stability of personal resources and factors mediating or moderating change across the adjustment trajectory.
Collapse
Affiliation(s)
- Emily Alice Bray
- The Hopkins Centre, Menzies Health Institute Queensland (Drs Bray, Hogan, and Mitchell, Dr Geraghty, and Dr Ownsworth), School of Applied Psychology (Dr Ownsworth) Griffith University, Brisbane, Queensland, Australia; and Division of Rehabilitation (Dr Geraghty), Metro South Health Hospital and Health Service, Brisbane, Queensland, Australia
| | | | | | | | | |
Collapse
|
2
|
Ownsworth T, Mols H, O'Loghlen J, Xie Y, Kendall M, Nielsen M, Mitchell J, Jones R, Geraghty T. Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge. Disabil Rehabil 2024; 46:1796-1806. [PMID: 37128900 DOI: 10.1080/09638288.2023.2205173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. METHODS 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. RESULTS Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. CONCLUSION Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.
Collapse
Affiliation(s)
- Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Helen Mols
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Yanfei Xie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Jessie Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
3
|
Borg SJ, Cameron CM, Luetsch K, Rolley A, Geraghty T, McPhail S, McCreanor V. Prevalence of opioid use in adults with spinal cord injury: A systematic review and meta-analysis. J Spinal Cord Med 2024:1-19. [PMID: 38466869 DOI: 10.1080/10790268.2024.2319384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To determine the prevalence, reported harms and factors associated with opioid use among adults with spinal cord injury (SCI) living in the community. STUDY DESIGN Systematic review and meta-analysis. METHODS Comprehensive literature searches were conducted in PubMed (MEDLINE), EMBASE, CINAHL, Web of Science and Scopus for articles published between 2000 and 2023. Risk of bias was assessed using a prevalence-specific tool. Random-effects meta-analyses were conducted to pool prevalence data for any context of opioids. Sensitivity and subgroup analyses were also performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study protocol was registered via Prospero (CRD42022350768). RESULTS Of the 4969 potential studies, 38 were included in the review. Fifty-three percent of studies had a low risk of bias, with a high risk of bias in 5% of studies. The pooled prevalence for the 38 studies included in the meta-analysis (total cohort size of 50,473) across any opioid context was 39% (95% confidence interval [CI], 32-47). High heterogeneity was evident, with a prediction interval twice as wide as the 95% CI (prediction interval, 7-84%). Mean or median opioid dose was unreported in 95% of studies. Opioid dose and factors related to opioids were also rarely explored in the SCI populations. CONCLUSIONS Results should be interpreted with caution based on the high heterogeneity and imprecise pooled prevalence of opioids. Contextual details including pain, cohort-specific injury characteristics and opioid dosage were inconsistently reported, indicating a clear need for additional studies in a population at greater risk of experiencing opioid-related adverse effects.
Collapse
Affiliation(s)
- Samantha J Borg
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Australia
| | - Cate M Cameron
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Australia
| | - Karen Luetsch
- School of Pharmacy, University of Queensland, Woolloongabba, Australia
| | - Adam Rolley
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
- Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Metro North Health, Herston, Australia
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
- Department of Rehabilitation, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Australia
| | - Steven McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Victoria McCreanor
- Hunter Medical Research Institute, New Lambton Heights, Australia
- University of Newcastle, Newcastle, Australia
| |
Collapse
|
4
|
Escorpizo R, Naud S, Post MWM, Schwegler U, Engkasan J, Halvorsen A, Geraghty T, Sadowsky C. Relationship between employment and quality of life and self-perceived health in people with spinal cord injury: an international comparative study based on the InSCI Community Survey. Spinal Cord 2024; 62:110-116. [PMID: 38160224 DOI: 10.1038/s41393-023-00953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Work-related disability is common in persons with spinal cord injury (SCI). The aims of this study are to examine the associations of employment with self-perceived health (SPH) and quality of life (QoL) across 22 countries and to explore the covariates around employment and SPH and QoL. SETTING Community. METHODS We analyzed 9494 community-dwelling persons with SCI aged 18-65. We performed an adjusted regression and path analysis. The independent variable was 'employment' and the dependent variables were two single items: QoL (very poor to very good) and SPH (excellent to poor). Covariates included the Gross Domestic Product (GDP), education, time since SCI, age, gender, years of employment after SCI, SCI level (paraplegia, tetraplegia), and completeness of SCI. RESULTS Participants' mean age was 47, 74% were male, and 63% had paraplegia. We found an association between employment and QoL and SPH. While the magnitude of the effect of employment on QoL did not differ across GDP quartiles, its perceived effect on QoL was found to be significant in the highest GDP quartile. Employment was predictive of good SPH in two GDP quartiles (Q1 and Q4), but significant across all quartiles when predicting poor perceptions, with the magnitude of effect varying significantly. CONCLUSIONS Employment is closely related to QoL and SPH depending on the GDP. We may positively influence the QoL and SPH in the SCI population to promote better employment outcomes by considering the infrastructure and economy.
Collapse
Affiliation(s)
- Reuben Escorpizo
- The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA.
- Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Shelly Naud
- The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Brain Center, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Centre Groningen, Centre for Rehabilitation, Groningen, The Netherlands
| | - Urban Schwegler
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Annette Halvorsen
- Clinic of Rehabilitation, Department of Spinal Cord Injuries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Timothy Geraghty
- Division of Rehabilitation, Princess Alexandra Hospital, and The Hopkins Centre, Metro South Health and Griffith University, Brisbane, Australia
| | - Cristina Sadowsky
- Kennedy Krieger Institute / Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Fergusson M, Maley M, Geraghty T, Albaladejo JP, Mason C, Rocchi MS. Validation of a multiplex-tandem RT-PCR for the detection of bovine respiratory disease complex using Scottish bovine lung samples. Vet J 2024; 303:106058. [PMID: 38103886 DOI: 10.1016/j.tvjl.2023.106058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
The welfare and economic impact of bovine respiratory disease complex (BRDC), and its associated antibiotic usage, are major challenges to cattle rearing and beef cattle finishing industries. Accurate pathogen diagnosis is important to undertake appropriate treatment and long-term management strategies, such as vaccine selection. Conventional diagnostic approaches have several limitations including high costs, long turnaround times and difficulty in test interpretation, which could delay treatment decisions and lead to unnecessary animal losses. We describe the validation of a multiplex-tandem (MT) reverse transcription-polymerase chain reaction (RT-PCR) for the detection of seven common pathogens associated with BRDC. This test has the potential to advance pathogen identification and to overcome many of the limitations of current testing methods. It requires a single sample and results are obtained quickly and not influenced by prior antimicrobial therapy or overgrowth of contaminating organisms. We demonstrated a test specificity of 100% and sensitivity ranging from 93.5% to 100% for these seven common pathogens. This test will be a useful addition to advance BRDC investigation and diagnosis.
Collapse
Affiliation(s)
- M Fergusson
- SRUC Veterinary and Analytical Services, Pentland Science Park, Bush Loan Road, Edinburgh, Scotland EH26 0PZ, UK
| | - M Maley
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland EH26 0PZ, UK
| | - T Geraghty
- SRUC Veterinary and Analytical Services, Pentland Science Park, Bush Loan Road, Edinburgh, Scotland EH26 0PZ, UK
| | - J Palarea Albaladejo
- Department of Computer Sciences, Applied Mathematics and Statistics, University of Girona, Girona 17003, Spain; Biomathematics and Statistics Scotland, The King's Buildings, Peter Guthrie Tait Road, Edinburgh, Scotland EH9 3FD, UK
| | - C Mason
- SRUC Veterinary and Analytical Services, Pentland Science Park, Bush Loan Road, Edinburgh, Scotland EH26 0PZ, UK
| | - M S Rocchi
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Penicuik, Scotland EH26 0PZ, UK.
| |
Collapse
|
6
|
O'Loghlen J, Geraghty T, Kendall M, Nielsen M, Jones R, McLennan V, Watter K, Ownsworth T. Perceived vocational support needs and return-to-work outcomes in the first 12-months post-discharge in individuals with acquired brain injury and spinal cord injury: A retrospective cohort study. Work 2024; 77:275-293. [PMID: 37638466 DOI: 10.3233/wor-230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Return-to-work (RTW) is often viewed as an important outcome following acquired brain injury (ABI) and spinal cord injury (SCI), although not all individuals have vocational goals and many experience barriers to RTW. OBJECTIVE This study investigated the relationship between RTW and psychosocial functioning at 12-months post-discharge after ABI and SCI and examined patterns of RTW according to perceived need for and receipt of vocational support. METHODS A file audit was conducted for 69 participants with ABI (n = 44) and SCI (n = 25). Data on employment status and perceived vocational support at 3- and 12-months post-discharge, home and community participation, psychological distress, and health-related quality of life were extracted. RESULTS Individuals in paid employment at 12-months post-discharge (22%, n = 15) reported significantly better psychosocial functioning at this timepoint compared to those not employed (78%; n = 54). For those not employed, three subgroups were identified: 1) Did not perceive the need for or receive vocational support (50%; n = 27); 2) Perceived vocational support needs were unmet (19%; n = 10); and 3) Perceived and received vocational support (31%; n = 17). Psychological distress was highest for those who perceived and received vocational support but were not employed. CONCLUSION RTW was associated with better psychosocial functioning after acquired neurological injury. The findings highlight the need for clinicians to explore and revisit individuals' perceived need for and preferences for vocational support and monitor the psychological well-being of those with RTW goals that are not yet successful.
Collapse
Affiliation(s)
- Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Vanette McLennan
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Kerrin Watter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| |
Collapse
|
7
|
Kifley A, Arora M, Nunn A, Marshall R, Geraghty T, Weber G, Urquhart S, Craig A, Cameron ID, Middleton JW. Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey: 3. Drivers of quality of life in people with spinal cord injury. Spinal Cord 2023; 61:185-193. [PMID: 35995988 PMCID: PMC10023557 DOI: 10.1038/s41393-022-00845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional population-based survey for the Australian cohort of the International Spinal Cord Injury (InSCI) Community Survey. OBJECTIVES To differentiate subgroups of people with spinal cord injury (SCI) who self-report good and poor overall quality of life (QoL) using domains of the International Classification of Functioning (ICF), and to evaluate how these factors contribute to QoL when considered together, while controlling confounders. SETTING Australian survey data from four state-wide SCI services, one government insurance agency, and three not-for-profit consumer organisations. METHODS Explanatory factors for QoL were compared between participants reporting poor vs. good QoL. Path models estimated total, direct and mediated contributions from each explanatory factor to QoL ratings after accounting for confounders. RESULTS Most participants (62%) reported good or very good QoL, 12% reported poor or very poor QoL. When explanatory factors were considered together, the strongest total effects on QoL involved social integration (+0.36 SDs), subjective social position (+0.29), secondary health condition burden (-0.28), activity/participation problem burden (-0.26), day-to-day assistance (-0.26), mental health (+0.18), pain (-0.16), self-efficacy (+0.15), vitality (+0.14) and environmental barriers (-0.11). Effects of social integration, mental health, vitality, self-efficacy, pain and activity/participation problems were partly or wholly direct. CONCLUSION Opportunities to improve QoL in people with SCI exist at every level of the health system. Virtually all aspects of the ICF framework make a substantive difference to QoL outcomes. Social and psychological factors and ability to complete desired activities have key direct effects and influence effects of secondary health condition burden and environmental barriers.
Collapse
Affiliation(s)
- Annette Kifley
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, VIC, Australia
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Timothy Geraghty
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia
- The Hopkins Centre, Griffith University, Brisbane, QLD, Australia
| | - Gerard Weber
- Spinal Injury Unit, Royal Rehab, Ryde, NSW, Australia
| | - Sue Urquhart
- Queensland Spinal Cord Injury Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- State Spinal Cord Injury Service, Agency for Clinical Innovation, St Leonards, NSW, Australia
- Spinal Outreach Service, Royal Rehab, Ryde, NSW, Australia
| |
Collapse
|
8
|
Middleton JW, Arora M, Kifley A, Geraghty T, Borg SJ, Marshall R, Clark J, Nunn A, Ferrante A, Fekete C, Stucki G, Gopinath B, Craig A, Cameron ID. Australian arm of the International Spinal Cord Injury (Aus-InSCI) community survey: 1. population-based design, methodology and cohort profile. Spinal Cord 2023; 61:194-203. [PMID: 36153439 PMCID: PMC10023561 DOI: 10.1038/s41393-022-00850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES To describe design and methods of Australian arm of International Spinal Cord Injury (Aus-InSCI) community survey, reporting on participation rates, potential non-response bias and cohort characteristics. SETTING Survey of community-dwelling people with SCI at least 12 months post-injury, recruited between March 2018 and January 2019, from state-wide SCI services, a government insurance agency and not-for-profit consumer organisations across four Australian states. METHODS The Aus-InSCI survey combined data for people with SCI from nine custodians, using secure data-linkage processes, to create a population-based, anonymised dataset. The Aus-InSCI questionnaire comprised 193 questions. Eligibility, response status and participation rates were calculated. Descriptive statistics depict participant characteristics. Logistic regression models were developed for probability of participation, and inverse probability weights generated to assess potential non-response bias. RESULTS 1579 adults with SCI were recruited, a cooperation rate of 29.4%. Participants were predominantly male (73%), with 50% married. Mean age was 57 years (range 19-94) and average time post-injury 17 years (range 1-73). Paraplegia (61%) and incomplete lesions (68%) were most common. Males were more likely than females to have traumatic injuries (p < 0.0001) and complete lesions (p = 0.0002), and younger age-groups were more likely to have traumatic injuries and tetraplegia (p < 0.0001). Potential non-response bias evaluated using selected outcomes was found to be negligible in the Aus-InSCI cohort. CONCLUSIONS The Aus-InSCI survey made efforts to maximise coverage, avoid recruitment bias and address non-response bias. The distributed, linked and coded (re-identifiable at each custodian level) 'virtual quasi-registry' data model supports systematic cross-sectional and longitudinal research.
Collapse
Affiliation(s)
- James W Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- State Spinal Cord Injury Service, Agency for Clinical Innovation, St Leonards, NSW, Australia.
- Spinal Outreach Service, Royal Rehab, Ryde, NSW, Australia.
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Timothy Geraghty
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia
- The Hopkins Centre, Griffith University, Brisbane, QLD, Australia
| | - Samantha J Borg
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia
- The Hopkins Centre, Griffith University, Brisbane, QLD, Australia
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jillian Clark
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, VIC, Australia
| | - Anna Ferrante
- School of Population Health, Curtin University, Bentley, WA, Australia
| | - Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Bamini Gopinath
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Macquarie University Hearing, Macquarie University, Sydney, NSW, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
- Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Watson PK, Arora M, Middleton JW, Quel de Oliveira C, Heard R, Nunn A, Geraghty T, Marshall R, Davis GM. Leisure-Time Physical Activity in People With Spinal Cord Injury-Predictors of Exercise Guideline Adherence. Int J Public Health 2022; 67:1605235. [PMID: 36579138 PMCID: PMC9790928 DOI: 10.3389/ijph.2022.1605235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives: This study described leisure-time physical activity (LTPA) for people in Australia with spinal cord injury (SCI) and whether certain sociodemographic and psychosocial variables might be associated with LTPA uptake and guidelines adherence. Methods: The Physical Activity Scale for Individuals with a Physical Disability was used to measure the intensity and volume of LTPA of 1,579 individuals with SCI. Summary statistics were calculated for LTPA guidelines adherence. Analyses included regression modelling. Results: Of the 1,579 participants, 58% performed LTPA and 13% adhered to recommended guidelines for weekly LTPA. There was an association with being an "exerciser" based on the time since injury (OR = 1.02 [95% 1.01-1.03]), a traumatic injury (OR = 1.53 [95% CI 1.13-2.08]) and a higher self-rating of health (OR = 1.10 [95% CI 0.95-1.27]). Where LTPA guidelines were met, adherence was most related to a traumatic injury (OR = 1.75 [95% CI 1.02-3.02]) and being unemployed (OR = 1.53 [95% CI 1.03-2.25]). Conclusion: Of those who performed LTPA with SCI, one in four met population-specific LTPA guidelines. Sociodemographic variables were moderately associated with being an "exerciser" or LTPA "guideline-adherent."
Collapse
Affiliation(s)
- Paul K. Watson
- Discipline of Exercise and Sport Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia,*Correspondence: Paul K. Watson,
| | - Mohit Arora
- Northern Sydney Local Health District, John Walsh Centre for Rehabilitation Research, The Kolling Institute, Sydney, NSW, Australia,Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James W. Middleton
- Northern Sydney Local Health District, John Walsh Centre for Rehabilitation Research, The Kolling Institute, Sydney, NSW, Australia,Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Camila Quel de Oliveira
- Department of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Robert Heard
- Discipline of Behavioural and Social Sciences in Health, Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, VIC, Australia
| | - Timothy Geraghty
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia,The Hopkins Centre, Griffith University, Brisbane, QLD, Australia
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, SA, Australia,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Glen M. Davis
- Discipline of Exercise and Sport Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
10
|
Borg SJ, Borg DN, Arora M, Middleton JW, Marshall R, Nunn A, Geraghty T. Factors Related to Engagement in Employment After Spinal Cord Injury in Australia: A Cross-sectional Study. Arch Phys Med Rehabil 2022; 103:2345-2354. [PMID: 35584739 DOI: 10.1016/j.apmr.2022.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/05/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore the association between sociodemographic, health, functional independence, and environmental variables with engagement in paid work for people with spinal cord injury (SCI). DESIGN Self-reported, cross-sectional Australian data from a large international SCI survey. SETTING Community-based. PARTICIPANTS 1189 working-age people with SCI (18-67 years) or aged >67 years and engaged in paid employment. Respondents were community based and at least 1 year after injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Employment and work integration variables. Bayesian penalized regression was used to determine associations between 23 predictor variables and engagement in paid work. RESULTS Most participants (87%) were employed pre-injury, with 39% in paid employment at the time of the survey. Participants who attained a master's/doctoral degree (odds ratio [OR]=3.01; 95% credible interval [CrI], 1.63, 5.44) and those married (OR=1.68; 95% CrI, 1.13, 2.49) were more likely to be engaged in paid work. Women (OR=0.55; 95% CrI, 0.37, 0.81), people receiving a disability pension (OR=0.17; 95% CrI, 0.13, 0.24), and older participants (OR=0.75; 95% CrI, 0.63, 0.90) were less likely to be in paid work. Working participants identified hardships including problems completing their work (60%) and accessing the workplace (32%), as well as unmet needs relating to assistive devices required for completing their work (50%). CONCLUSIONS Findings from the current study can assist in directing resources to subgroups within the SCI population who need greater assistance or intervention related to employment outcomes, including through vocational rehabilitation services/programs. Unmet needs and workplace issues expressed by employed individuals identify gaps in work integration and satisfaction that could affect employment sustainability that need to be addressed.
Collapse
Affiliation(s)
- Samantha J Borg
- From the The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane.
| | - David N Borg
- From the The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards; Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, St Leonards; Sydney Medical School-Northern, Faculty of Medicine and Health, The University of Sydney, Sydney
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg
| | - Timothy Geraghty
- From the The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane; Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
11
|
McCreery A, Leahy A, Geraghty T, Boyle N. 276 SENSORY DEPRIVATION IN OLDER MEDICAL INPATIENTS: ARE WE AWARE ENOUGH? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Visual and hearing impairment is common amongst older adults admitted to the acute hospital setting. Sensory deprivation can contribute to falls and incidence of delirium, particularly in those who have underlying cognitive impairment. Interventions which reduce sensory deprivation have been recommended to avoid these complication [1].
Methods
Patients over 75 admitted to 11 medical wards in a University Teaching Hospital were assessed. Baseline demographics were collected. Documentation regarding hearing and visual impairment, delirium, completion of 4 AT, and underlying cognitive impairment was reviewed. Inpatient falls were documented.
Results
100 older adults were included in the audit. (Mean age: 83.5 years). 73% of patients had a visual impairment and 23% had a hearing impairment. 67% had access to their glasses and only 27% of patients had access to their hearing aids. Documentation of sensory disability in either medical or nursing notes was 19%. 29% of patients had documented delirium during their inpatient stay. 4AT was performed on 76% of admitted older adults in the selected wards.
Conclusion
Visual and hearing impairment is common amongst older admitted medical inpatients. Despite this, there can be a lack of access to glasses and hearing aids. There is a paucity of documentation regarding sensory deprivation, therefore interventions targeting this risk factor for delirium may not be allocated to the cohort most at risk. We recommend strategies highlighting awareness of sensory deprivation in older adults admitted to hospital.
Reference
1. Surkan MJ and Gibson W. Interventions to mobilize elderly patients and reduce length of hospital stay. Canadian Journal of Cardiology. 2018 34(7), pp. 881–888.
Collapse
Affiliation(s)
- A McCreery
- St. Vincent’s University Hospital , Dublin, Ireland
| | - A Leahy
- St. Vincent’s University Hospital , Dublin, Ireland
| | - T Geraghty
- St. Vincent’s University Hospital , Dublin, Ireland
| | - N Boyle
- St. Vincent’s University Hospital , Dublin, Ireland
| |
Collapse
|
12
|
Borg DN, Bon JJ, Foster MM, Lakhani A, Kendall M, Geraghty T. Healthcare services for people with acquired disability in South-East Queensland, Australia: Assessing potential proximity and its association with service obstacles. SSM Popul Health 2022; 19:101209. [PMID: 36052155 PMCID: PMC9424535 DOI: 10.1016/j.ssmph.2022.101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
This study described access potential in South-East Queensland, to healthcare services commonly used by people with acquired disability; and investigated the association between service proximity and perceived service obstacles. First, we described accessibility by conducting a spatial analysis to create maps of potential accessibility to health services in South-East Queensland. Queensland statistical area level 2 (SA2) locations were combined with the residential locations of participants from a longitudinal cohort study involving people with ABI and SCI. The locations of selected health services of interest were identified from Health Direct's National Health Service Directory. Travel times via motor vehicle were modelled with Robust Gaussian Stochastic Process, to smoothly interpolate between the sparse time-to-service observations. Probabilistic predicted values were generated from the model and were used to construct service accessibility maps of South-East Queensland. Disability population data were used to identify SA2s with relatively low service access but a high disability population. Second, we examined perceived service obstacles, by investigating the relationship between potential access to services and perceived service obstacles was examined using data from 63 people with ABI or SCI discharged from the specialist state-wide rehabilitation services, located in South-East Queensland. Obstacles to accessing service in relation to resource availability, transportation and finances were collected three-months after discharge, using the Service Obstacle Scale. Travel times to the closest health service were computed for each individual and were compared to their Service Obstacle Scale responses. Access potential was highly variable, particularly for allied health services. We identified several low-access, high-disability population areas. These hotpots of poor access were generally to the north and west of greater Brisbane. Longer travel times to allied health services were associated with 260% higher odds of agreeing that resource availability was an obstacle to accessing services. Policy makers should be concerned with the hotspots of poor access identified. There was considerable variability in access potential, which was generally greater for allied health than medical specialist services. We highlighted low-access high disability population areas, which were generally in outer suburbia. Poorer potential access to allied health services was associated with resource availability being rated as an service obstacle. We did not find any evidence that proximity to allied health services was associated with transportation or finance obstacles.
Collapse
Affiliation(s)
- David N Borg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Joshua J Bon
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Brisbane, Australia.,School of Mathematical Sciences, Queensland University of Technology, St Lucia, Brisbane, Australia
| | - Michele M Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Ali Lakhani
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,School of Health Sciences and Social Work, Griffith University, Brisbane, Australia.,La Trobe University, Melbourne, Australia
| | - Melissa Kendall
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
13
|
Borg DN, Fleming J, Bon JJ, Foster MM, Kendall E, Geraghty T. The influence of personal factors, unmet need and service obstacles on the relationship between health service use and outcome after brain injury. BMC Health Serv Res 2022; 22:445. [PMID: 35382821 PMCID: PMC8980503 DOI: 10.1186/s12913-022-07811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 03/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background This exploratory study aimed to: (i) examine the relationship between health service use and quality of life, psychological wellbeing, global function and participation after discharge from brain injury inpatient rehabilitation, and (ii) determine the influence of personal factors, unmet need for services and service obstacles on the relationship between service use and these outcomes. Methods Using a prospective cohort design, 41 adults with acquired brain injury (median age = 46 years; 71% male; 61% severe traumatic injury) were followed for 6-months after discharge from specialist brain injury inpatient rehabilitation. Service use was continuously recorded and obtained through data linkage methods, focusing on the use of: outpatient medical services, outpatient nursing, outpatient allied health; medical acute services; incidents of re-hospitalization; and transitional rehabilitation service use. Outcome questionnaire measures were completed via telephone, at 6-months after discharge, and included: the EuroQol-5D; Depression Anxiety and Stress Scale, Mayo-Portland Adaptability Inventory and Sydney Psychosocial Reintegration Scale. Data were analyzed in a heterogeneous treatment effects framework, using Bayesian Additive Regression Trees. Results There was weak evidence that transitional rehabilitation service use was associated with better psychological wellbeing scores. The posterior probability of lower depression, anxiety and stress scores was .87, .81 and .86, respectively (average treatment effect). There was also weak evidence that re-hospitalization was associated with worse independent living skills scores. The posterior probability of worse scores was .87. However, most re-hospitalizations were due to unavoidable medical complications. We did not find that place of residence at discharge, marital status, unmet need, or service obstacles affected the relationship between service use and the studied outcomes. Conclusions This study may highlight the importance of participation in transitional rehabilitation, in the 6-months after discharge from brain injury rehabilitation. Replication in a larger sample size is required to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07811-y.
Collapse
Affiliation(s)
- David N Borg
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia. .,Griffith University, School of Allied Health Sciences, Brisbane, Australia.
| | - Jennifer Fleming
- University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Joshua J Bon
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Brisbane, Australia.,Queensland University of Technology, School of Mathematical Sciences, Brisbane, Australia
| | - Michele M Foster
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Griffith University, School of Allied Health Sciences, Brisbane, Australia
| | - Elizabeth Kendall
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Griffith University, School of Allied Health Sciences, Brisbane, Australia
| | - Timothy Geraghty
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, Australia.,Metro South Health Hospital and Health Service, Division of Rehabilitation, Brisbane, Australia
| |
Collapse
|
14
|
Borg SJ, Borg DN, Foster MM, Bell R, Bowley J, Geraghty T. Use and cost of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme services following inpatient rehabilitation for acquired disability in Australia. AUST HEALTH REV 2022; 47:165-174. [PMID: 36543263 DOI: 10.1071/ah22118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
Objectives This study explored publicly funded health system and patient expenditure in the post-acute phase following discharge from inpatient acquired brain injury (ABI) or spinal cord injury (SCI) rehabilitation. The secondary aim was to explore sociodemographic and injury characteristics associated with high costs. Methods This was a prospective cohort study. 153 patients (ABI: n = 85; SCI: n = 68) who consented to the use of their Medicare data were recruited between March 2017 and March 2018, at the point of discharge from ABI or SCI specialist rehabilitation units. The main outcome measure involved linkage of the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data for the 12 months following discharge from rehabilitation. Bayesian penalised regression was used to determine characteristics associated with high costs. Results The median number of MBS items used in the 12 months after discharge was 33 (IQR: 21-52). General practitioners and allied health services were accessed by 100% and 41% of the cohort, respectively. The median MBS system cost (in Australian dollars) was $2006 (IQR: $162-$3090). Almost half (46%) of the participants had no MBS patient expenditure. The median PBS system cost was $541 (IQR: $62-$1574). For people with ABI, having a traumatic injury or one comorbidity was associated with lower PBS system costs by on average $119 and $134, respectively. We also found that hospitalisation in ABI was associated with higher PBS system costs, by on average $669. Conclusion There was evidence of high and variable MBS and PBS costs, raising concerns about financial hardship. Future research should focus on identifying any unmet service and prescription needs in the post-acute rehabilitation phase for these populations.
Collapse
Affiliation(s)
- Samantha J Borg
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - David N Borg
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - Michele M Foster
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - Ryan Bell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia; and Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Jessica Bowley
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia; and Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Qld, Australia
| |
Collapse
|
15
|
Legg M, Foster M, Jones R, Kendall M, Fleming J, Nielsen M, Kendall E, Borg D, Geraghty T. The impact of obstacles to health and rehabilitation services on functioning and disability: a prospective survey on the 12-months after discharge from specialist rehabilitation for acquired brain injury. Disabil Rehabil 2021; 44:5919-5929. [PMID: 34270367 DOI: 10.1080/09638288.2021.1952321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Little is known about obstacles to health and rehabilitation services experienced by people with acquired brain injury (ABI) over time and what impact these have on recovery. This study utilised the International Classification of Functioning, Disability, and Health model to better understand the impact of service obstacles. The aims were: (1) describe and compare service obstacles reported in the 12-months post-discharge from inpatient rehabilitation; (2) examine service obstacles as a moderator of the relationship between functional impairment and activities and participation. MATERIALS AND METHODS Prospective survey of 41 people who received ABI inpatient rehabilitation in Queensland, Australia. Validated self-report measures of service obstacles, functional impairment, and activities and participation were administered at 6- and 12-months post-discharge. RESULTS Transportation was the highest-rated obstacle at 6-months post-discharge, and this decreased at 12-months. Dissatisfaction with treatment resources and financial obstacles were, on average, low-to-moderate and remained constant. Specifically, the moderation analyses showed that financial obstacles may exacerbate the negative impact of functional impairment on independent living skills. CONCLUSIONS Our findings suggest that people living in Queensland, Australia, who experience financial obstacles to services after brain injury may be at risk of poorer recovery outcomes. Rehabilitation policy should consider prioritising individuals who experience financial obstacles to accessing services.IMPLICATIONS FOR REHABILITATIONIn Queensland, Australia, financial obstacles to accessing health services after brain injury may exacerbate the negative impact of functional impairment on independent living skills, in the first 12-months after hospital discharge.There may be a need to prioritize rehabilitation policy that targets individuals who experience financial obstacles to accessing health and rehabilitation services, after brain injury, irrespective of a health system's potential to enable access.
Collapse
Affiliation(s)
- Melissa Legg
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia
| | - Michele Foster
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia
| | - Rachel Jones
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
| | - Melissa Kendall
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Mandy Nielsen
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
| | - Elizabeth Kendall
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia
| | - David Borg
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia
| | - Timothy Geraghty
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
16
|
Legg M, Foster M, Parekh S, Nielsen M, Jones R, Kendall E, Fleming J, Geraghty T. Trajectories of Rehabilitation across Complex Environments (TRaCE): design and baseline characteristics for a prospective cohort study on spinal cord injury and acquired brain injury. BMC Health Serv Res 2019; 19:700. [PMID: 31615532 PMCID: PMC6794776 DOI: 10.1186/s12913-019-4564-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/26/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Trajectories of Rehabilitation across Complex Environments (TRaCE), a consented prospective cohort study, addresses a critical need to better understand access to the healthcare system after acute treatment and specialist inpatient rehabilitation for acquired disability. It is expected that this study will produce new knowledge on access to healthcare through the linkage of administrative, survey, and spatial datasets on the one cohort. This paper outlines the study design and baseline characteristics of the cohort. METHODS The TRaCE cohort is comprised of 165 inpatients who are currently being followed up for 12 months after discharge from specialist rehabilitation for acquired brain injury (ABI) and spinal cord injury (SCI). This project combines a data linkage framework on health service use with a prospective survey on psychosocial wellbeing, geographical information systems to examine spatial accessibility to services, and qualitative interviews with a sub-cohort on experiences of service access. CONCLUSION Ultimately, TRaCE will have strong translational impact on strategies for more targeted interventions to improve the healthcare system and support individuals with acquired disabilities in the long-term.
Collapse
Affiliation(s)
- Melissa Legg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Sanjoti Parekh
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Mandy Nielsen
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Rachel Jones
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Elizabeth Kendall
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| |
Collapse
|
17
|
Gao F, Foster M, Newcombe P, Geraghty T. Applying bifactor modelling to improve the clinical interpretive values of Functional Independence Measure in adults with acquired brain injury. Disabil Rehabil 2018; 42:1753-1761. [PMID: 30499346 DOI: 10.1080/09638288.2018.1531153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To apply a modern robust approach, bifactor modeling, to critically examine psychometric properties of Functional Independence Measure (FIM) in adults with acquired brain injury and to propose a solution to improve the clinical interpretive values of the FIM to inform policy and clinical practice.Methods: The data came from a state-wide specialist in-patient brain injury rehabilitation service in Queensland, Australia for adults with acquired brain injury and discharged between 2012 and 2017. The sample included 457 people. Three measurement models (unidimensional, correlated first-order and bifactor) for FIM were tested using confirmatory factor analysis with structural equation modeling. Then, model-based reliability and incremental validity were assessed.Results: The bifactor model best fit the data. When operationalized as latent factors under structural equation modeling framework, general care burden had a large predictive effect, while Motor and Cognitive showed medium and small predictive effects respectively on rehabilitation length of stay.Conclusions: The total score of FIM was a reliable measure of general care burden, while the subscale scores were not. A solution is to apply a bifactor modeling approach based on structural equation modeling to disentangle the unique variance attributable to Motor and Cognitive factors. In the structural equation modeling framework, the FIM demonstrated good incremental validity to inform policy and clinical practice.Implications for rehabilitationClinicians and researchers can confidently use FIM total score in adults with acquired brain injury.The current study proposed an alternative solution to the poor reliability of Motor and Cognitive scores, that is, by applying a bifactor modeling approach, the unique contributions of the Motor and Cognitive factors can be examined.The current study has demonstrated the strengths of bifactor modeling in the robust validation and interpretation of FIM to better inform clinical practice and policy decision-making.The current study has the potential to make an important contribution to enhance more equitable decision-making in the areas of national benchmarking of rehabilitation outcomes and other program eligibility criteria and funding allocation.
Collapse
Affiliation(s)
- Fengsong Gao
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Peter Newcombe
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia
| |
Collapse
|
18
|
Thomas F, Geraghty T, Simões P, Mshelbwala F, Haining H, Eckersall P. A pilot study of acute phase proteins as indicators of bovine mastitis caused by different pathogens. Res Vet Sci 2018; 119:176-181. [DOI: 10.1016/j.rvsc.2018.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/05/2018] [Accepted: 06/13/2018] [Indexed: 11/26/2022]
|
19
|
Galea M, Dunlop S, Geraghty T, Davis G, Nunn A, Olenko L. Intensive exercise program after spinal cord injury (SCIPA full-on): A randomized controlled trial. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
20
|
Galea MP, Dunlop SA, Geraghty T, Davis GM, Nunn A, Olenko L, Hurley M, Rehab R, Marshall R, Clark J, Acland R, Nunnerley J. SCIPA Full-On: A Randomized Controlled Trial Comparing Intensive Whole-Body Exercise and Upper Body Exercise After Spinal Cord Injury. Neurorehabil Neural Repair 2018; 32:557-567. [DOI: 10.1177/1545968318771213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. While upper body training has been effective for improving aerobic fitness and muscle strength after spinal cord injury (SCI), activity-based therapies intended to activate the paralyzed extremities have been reported to promote neurological improvement. Objective. To compare the effectiveness of intensive whole-body exercise compared with upper body exercise for people with chronic SCI. Methods. A parallel-group randomized controlled trial was conducted. Participants with a range of SCI levels and severity were randomized to either full-body exercise (FBE) or upper body exercise (UBE) groups (3 sessions per week over 12 weeks). FBE participants underwent locomotor training, functional electrical stimulation-assisted leg cycling, and trunk and lower extremity exercises, while UBE participants undertook upper body strength and aerobic fitness training only. The primary outcome measure was the American Spinal Injury Association (ASIA) motor score for upper and lower extremities. Adverse events were systematically recorded. Results. A total of 116 participants were enrolled and included in the primary analysis. The adjusted mean between-group difference was −0.04 (95% CI −1.12 to 1.04) for upper extremity motor scores, and 0.90 (95% CI −0.48 to 2.27) for lower extremity motor scores. There were 15 serious adverse events in UBE and 16 in FBE, but only one of these was definitely related to the experimental intervention (bilateral femoral condyle and tibial plateau subchondral fractures). No significant between-group difference was found for adverse events, or functional or behavioral variables. Conclusions. Full-body training did not lead to improved ASIA motor scores compared with upper body training in people with chronic SCI.
Collapse
Affiliation(s)
- Mary P. Galea
- The University of Melbourne, Parkville, Victoria, Australia
| | - Sarah A. Dunlop
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Research for Rehabilitation and Resilience, Metro South Health, and Griffith University, Logan Campus, Queensland, Australia
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Glen M. Davis
- The University of Sydney, Lidcombe, New South Wales, Australia
| | - Andrew Nunn
- Austin Health, Heidelberg, Victoria, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Burridge L, Foster M, Jones R, Geraghty T, Atresh S. Person-centred care in a digital hospital: observations and perspectives from a specialist rehabilitation setting. AUST HEALTH REV 2018; 42:529-535. [DOI: 10.1071/ah17156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/05/2017] [Indexed: 11/23/2022]
Abstract
Objective This study investigated use of electronic medical records (eMRs) in a spinal cord injury rehabilitation unit and the implications for person-centred care. Methods This exploratory mixed-methods study conducted 17.5 hours of observations of practitioner–patient encounters, 50 patient-experience surveys and 10 focus groups with 53 practitioners. Descriptive statistics and qualitative analysis were integrated into key themes. Results Practitioners in this specialised setting were reconciling the emergent challenges of eMR in practice with the advantages of improved accessibility and documentation legibility. eMR increased task complexity and information retrieval, particularly for nurses. Some documentation was an uneasy fit with the specialised setting, disrupting informal communications and aspects of person-centred care. Conclusions Technological change closely aligned with frontline practice brought expected and unexpected challenges that may resolve over time. Practitioners’ persistence and adaptability demonstrated their commitment to person-centred care in the digital environment. The impact of this less visible work of professional discretion seemed to vary, primarily by discipline-specific roles, with nurses experiencing the greatest pressure. What is known about this topic? Integrated electronic medical records (eMRs) bring benefits but challenge person-centred care. What does this paper add? These first insights regarding frontline implementation of eMR in spinal injury rehabilitation suggest nursing challenges when seeking to fit specialised work into the generic eMR. However, most patients reported receiving person-centred care. What are the implications for practitioners? Commitment to person-centred care appears to strengthen practitioners’ perseverance with the eMR implementation challenges.
Collapse
|
22
|
Battistuzzo CR, Armstrong A, Clark J, Worley L, Sharwood L, Lin P, Rooke G, Skeers P, Nolan S, Geraghty T, Nunn A, Brown DJ, Hill S, Alexander J, Millard M, Cox SF, Rao S, Watts A, Goods L, Allison GT, Agostinello J, Cameron PA, Mosley I, Liew SM, Geddes T, Middleton J, Buchanan J, Rosenfeld JV, Bernard S, Atresh S, Patel A, Schouten R, Freeman BJ, Dunlop SA, Batchelor PE. Early Decompression following Cervical Spinal Cord Injury: Examining the Process of Care from Accident Scene to Surgery. J Neurotrauma 2016; 33:1161-9. [DOI: 10.1089/neu.2015.4207] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Camila R. Battistuzzo
- Department of Medicine (Royal Melbourne Hospital), the University of Melbourne, Melbourne, Australia
| | - Alex Armstrong
- School of Animal Biology, the University of Western Australia, Perth Australia
| | - Jillian Clark
- Center for Orthopedic and Trauma Research, the University of Adelaide, Adelaide, Australia
| | - Laura Worley
- Queensland Spinal Injuries Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Lisa Sharwood
- John Walsh Center for Rehabilitation Research, the University of Sydney, Sydney, Australia
| | - Peny Lin
- Orthopedic Department, Middlemore Hospital, Auckland, New Zealand
| | - Gareth Rooke
- Orthopedic Department, Christchurch Hospital, Christchurch, New Zealand
| | - Peta Skeers
- Department of Medicine (Royal Melbourne Hospital), the University of Melbourne, Melbourne, Australia
| | - Sherilyn Nolan
- School of Animal Biology, the University of Western Australia, Perth Australia
| | - Timothy Geraghty
- Queensland Spinal Injuries Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Melbourne, Australia
| | | | - Steven Hill
- Victorian Spinal Cord Service, Austin Hospital, Melbourne, Australia
| | - Janette Alexander
- Victorian Spinal Cord Service, Austin Hospital, Melbourne, Australia
| | - Melinda Millard
- Victorian Spinal Cord Service, Austin Hospital, Melbourne, Australia
| | - Susan F. Cox
- Neuroscience Trials Australia, the Florey Institute of Neuroscience, Melbourne, Australia
| | - Sudhakar Rao
- Trauma Service, Royal Perth Hospital, Perth, Australia
| | - Ann Watts
- Spinal Unit, Royal Perth Hospital, Perth, Australia
| | - Louise Goods
- School of Animal Biology, the University of Western Australia, Perth Australia
| | - Garry T. Allison
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - Jacqui Agostinello
- Department of Medicine (Royal Melbourne Hospital), the University of Melbourne, Melbourne, Australia
| | - Peter A. Cameron
- Emergency and Trauma Center, the Alfred Hospital, Melbourne, Australia
| | - Ian Mosley
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Susan M. Liew
- Department of Orthopedic Surgery, the Alfred Hospital, Melbourne, Australia
| | - Tom Geddes
- Orthopedic Department, Middlemore Hospital, Auckland, New Zealand
| | - James Middleton
- John Walsh Center for Rehabilitation Research, the University of Sydney, Sydney, Australia
| | - John Buchanan
- Department of Physiotherapy, Royal Perth Hospital, Perth, Australia
| | | | - Stephen Bernard
- Intensive Care Unit, the Alfred Hospital, Melbourne, Australia
| | - Sridhar Atresh
- Queensland Spinal Injuries Service, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Alpesh Patel
- Orthopedic Department, Middlemore Hospital, Auckland, New Zealand
| | - Rowan Schouten
- Orthopedic Department, Christchurch Hospital, Christchurch, New Zealand
| | - Brian J.C. Freeman
- Department of Orthopedics and Trauma, the University of Adelaide, Adelaide, Australia
| | - Sarah A. Dunlop
- School of Animal Biology, the University of Western Australia, Perth Australia
| | - Peter E. Batchelor
- Department of Medicine (Royal Melbourne Hospital), the University of Melbourne, Melbourne, Australia
| |
Collapse
|
23
|
van de Pol E, Lucas K, Geraghty T, Pershouse K, Harding S, Atresh S, Wagemakers A, Smith AC. The delivery of specialist spinal cord injury services in Queensland and the potential for telehealth. BMC Health Serv Res 2016; 16:29. [PMID: 26810738 PMCID: PMC4727259 DOI: 10.1186/s12913-016-1256-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/06/2016] [Indexed: 11/26/2022] Open
Abstract
Background The Queensland Spinal Cord Injuries Service (QSCIS) is a statewide service in Brisbane at the Princess Alexandra Hospital (PAH). The QSCIS assists individuals with a spinal cord injury (SCI) through three services: the Spinal Injuries Unit (SIU), Transitional Rehabilitation Program (TRP) and the Spinal Outreach Team (SPOT). The aim of this study was to undertake a review of ambulatory services provided by the QSCIS (SIU and SPOT) to help identify where telehealth may potentially be useful. Methods Profiling of patients with SCI in Queensland was achieved using database records containing referral data. Services provided by SIU Outpatient Clinics and the SPOT during a 6-year period (January 2008 – December 2013), were analysed. Using postcodes, we estimated distances between place of residence and Brisbane. We compared the general population of SCI patients with patients managed through SIU Outpatient Clinics and the SPOT. Results During the 6-year period, 2073 patients were referred to the QSCIS (and living) at the time of the analysis. 74 % of all patients were male. The median age was 51y (IQR 39y-61y). About two-thirds of all patients lived within 200 km of Brisbane. 24 % of all patients registered with the QSCIS lived further than 200 km away from Brisbane. 7513 appointments were provided in the SIU outpatient clinic. 43,827 occasions of service were reported by the SPOT, including telephone consultations (66 %) and home visits (26 %). 72 outreach clinics were held in selected regional sites for up to 100 patients per year. 13 videoconference appointments reported. 90 % of all patients who attended the SIU outpatient clinic lived within 200 km of Brisbane. About two-thirds of patients who received a service from the SPOT lived within 200 km of Brisbane. Conclusion Since one third of all patients registered with the QSCIS live at least 200 km away from Brisbane; it appears that these patients may not be accessing the same services as Brisbane based patients. Telehealth models of care, which promote better engagement with local health service providers (such as general practitioners, nurse practitioners and allied health professionals) could improve equity of access and reduce the need for extensive travel.
Collapse
Affiliation(s)
- Eileen van de Pol
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands.
| | - Karen Lucas
- PAH Telehealth Centre, Metro South Health, Princess Alexandra Hospital, Queensland, Australia.
| | - Timothy Geraghty
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia.
| | - Kiley Pershouse
- Spinal Outreach Team, QLD Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia.
| | - Sandra Harding
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia.
| | - Sridhar Atresh
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia.
| | - Annemarie Wagemakers
- Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands.
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Queensland, Australia. .,Princess Alexandra Hospital, Postal: PAH Telehealth Centre, Ground Floor, Main Building, Princess Alexandra Hospital, Woolloongabba, 4102, Australia.
| |
Collapse
|
24
|
Middleton JW, Piccenna L, Lindsay Gruen R, Williams S, Creasey G, Dunlop S, Brown D, Batchelor PE, Berlowitz DJ, Coates S, Dunn JA, Furness JB, Galea MP, Geraghty T, Kwon BK, Urquhart S, Yates D, Bragge P. Developing a spinal cord injury research strategy using a structured process of evidence review and stakeholder dialogue. Part III: outcomes. Spinal Cord 2015; 53:729-37. [DOI: 10.1038/sc.2015.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 11/09/2022]
|
25
|
Hannon FP, Ellis KA, Guevar J, Marchesi F, Geraghty T, Leach JDG. Closantel toxicity in a pregnant ewe at mid gestation: the pathological evaluation of the ewe and lamb nine months later. Vet rec case rep 2014. [DOI: 10.1136/vetreccr-2014-000113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Fergus Patrick Hannon
- Scottish Centre for Production Animal Health and Food SafetySchool of Veterinary MedicineCollege of Medical Veterinary and Life SciencesUniversity of Glasgow
| | - Kathryn Amanda Ellis
- Scottish Centre for Production Animal Health and Food SafetySchool of Veterinary MedicineCollege of Medical Veterinary and Life SciencesUniversity of Glasgow
| | - Julien Guevar
- School of Veterinary MedicineCollege of Medical Veterinary and Life SciencesUniversity of GlasgowBearsden RoadGlasgowG61 1QHUK
| | - Francesco Marchesi
- School of Veterinary MedicineCollege of Medical Veterinary and Life SciencesUniversity of GlasgowBearsden RoadGlasgowG61 1QHUK
| | - Timothy Geraghty
- Scottish Centre for Production Animal Health and Food SafetySchool of Veterinary MedicineCollege of Medical Veterinary and Life SciencesUniversity of Glasgow
| | - Joshua David George Leach
- School of Veterinary MedicineCollege of Medical Veterinary and Life SciencesUniversity of GlasgowBearsden RoadGlasgowG61 1QHUK
| |
Collapse
|
26
|
Galea MP, Dunlop SA, Davis GM, Nunn A, Geraghty T, Hsueh YSA, Churilov L. Intensive exercise program after spinal cord injury ("Full-On"): study protocol for a randomized controlled trial. Trials 2013; 14:291. [PMID: 24025260 PMCID: PMC3848453 DOI: 10.1186/1745-6215-14-291] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/27/2013] [Indexed: 11/13/2022] Open
Abstract
Background Rehabilitation after spinal cord injury (SCI) has traditionally involved teaching compensatory strategies for identified impairments and deficits in order to improve functional independence. There is some evidence that regular and intensive activity-based therapies, directed at activation of the paralyzed extremities, promotes neurological improvement. The aim of this study is to compare the effects of a 12-week intensive activity-based therapy program for the whole body with a program of upper body exercise. Methods/Design A multicenter, parallel group, assessor-blinded randomized controlled trial will be conducted. One hundred eighty-eight participants with spinal cord injury, who have completed their primary rehabilitation at least 6 months prior, will be recruited from five SCI units in Australia and New Zealand. Participants will be randomized to an experimental or control group. Experimental participants will receive a 12-week program of intensive exercise for the whole body, including locomotor training, trunk exercises and functional electrical stimulation-assisted cycling. Control participants will receive a 12-week intensive upper body exercise program. The primary outcome is the American Spinal Injuries Association (ASIA) Motor Score. Secondary outcomes include measurements of sensation, function, pain, psychological measures, quality of life and cost effectiveness. All outcomes will be measured at baseline, 12 weeks, 6 months and 12 months by blinded assessors. Recruitment commenced in January 2011. Discussion The results of this trial will determine the effectiveness of a 12-week program of intensive exercise for the whole body in improving neurological recovery after spinal cord injury. Trial registration NCT01236976 (10 November 2010), ACTRN12610000498099 (17 June 2010).
Collapse
Affiliation(s)
- Mary P Galea
- Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, VIC 3010, Australia.
| | | | | | | | | | | | | |
Collapse
|
27
|
MacBean N, Ward E, Murdoch B, Cahill L, Geraghty T. Phonation after cervical spinal cord injury (CSCI): prospective case examinations of the acute and sub-acute stages of recovery. Int J Speech Lang Pathol 2013; 15:312-323. [PMID: 23642209 DOI: 10.3109/17549507.2013.777784] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of the investigation was to examine the changes in phonation and related quality-of-life in the acute and sub-acute stages of recovery post-cervical spinal cord injury (CSCI). A prospective examination of phonation was conducted using perceptual and instrumental measures of respiratory and laryngeal functioning alongside a quality-of-life rating scale. Change was present across measures for both cases at each time point. Overall, a general pattern of recovery was seen, although some areas deteriorated between 6-12 months. Severity of impairments, extent of change, and impact on quality-of-life differed between the cases. Measures varied in sensitivity to change in function. Phonation can be impaired following both complete and incomplete CSCI, with type and severity of impairment/s undergoing change throughout the acute and sub-acute period post-injury. Spontaneous physiological recovery does not necessarily result in improved phonation and/ or quality-of-life. Potential exists for targeted speech-language therapy in this population, throughout recovery, to best capitalize on the physical changes that are occurring and to maximize functional application of skills to improve quality- of-life. Further research is warranted to examine this recovery period on a larger scale.
Collapse
|
28
|
Kendall M, Fronek P, Ungerer G, Malt J, Eugarde E, Geraghty T. Assessing Professional Boundaries in Clinical Settings: The Development of the Boundaries in Practice Scale. Ethics & Behavior 2011. [DOI: 10.1080/10508422.2011.622186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
29
|
Geraghty T, O'Grady L, Mulligan FJ. An investigation into reduced milk production following dietary alteration on an Irish dairy farm. Ir Vet J 2010; 63:689-94. [PMID: 21851742 PMCID: PMC3113839 DOI: 10.1186/2046-0481-63-11-689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A nutritional evaluation of an Irish dairy herd indicated gross overfeeding of late lactation cows, over-conditioning of cows at parturition and a high rate of body condition loss in early lactation. Metabolisable-energy based nutritional modelling software was used to guide recommended dietary changes to prevent excessive condition gain in late lactation. Immediately following the implementation of the changes there was an unexpected reduction in performance affecting both milk yield and protein concentration. An investigation into the poor performance revealed underestimation of peak milk yield; over-estimation of maize silage quality; a large difference in the concentrate being fed compared to the concentrate recommended, and failure of the blend of concentrate ingredients to maintain the intended proportions in the in-parlour feeding system. The estimated maximum cumulative effect of these errors was to cause undersupply of energy and protein in the recommended diet of 16% and 3% respectively to cows in early lactation. Use of a net-energy nutritional model would have indicated a requirement for a higher energy supply in this case. This report highlights the challenges in obtaining accurate on-farm data for use in dairy cow nutritional models.
Collapse
Affiliation(s)
- Timothy Geraghty
- School of Agriculture, Food Science and Veterinary Medicine, UCD, Dublin 4, Ireland
| | | | | |
Collapse
|
30
|
Fronek P, Kendall M, Ungerer G, Malt J, Eugarde E, Geraghty T. Towards healthy professional-client relationships: the value of an interprofessional training course. J Interprof Care 2010; 23:16-29. [PMID: 19142780 DOI: 10.1080/13561820802491006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Boundary violations that threaten professional-client relationships are rarely discussed at the coalface. There is an assumption that healthcare practitioners have the skills necessary to manage professional boundary dilemmas with clients. The issue, if addressed, is usually confined to discipline specific education and training. A one-day Professional Boundaries for Health Professionals (PBHP) training program was developed in response to real life practice dilemmas experienced by health practitioners across the continuum of care. The program was delivered to 109 participants throughout the state of Queensland, Australia, from government and non-government organizations. Participants were doctors, nurses, allied health (physiotherapists, occupational therapists, social workers, psychologists, dietitians, speech therapists), therapy assistants and personal care staff from a diverse range of hospital and community settings. Evaluations of PBHP suggest that the interprofessional learning context was valued with specific advantages identified in the use of adult learning approaches, the teaching of ethical decision making principles, the value of supervision and peer support and the opportunities provided for critical reflection. The effectiveness of training for healthcare practitioners in this area is discussed as a meaningful way of developing skills and engendering collaborative relationships between professional (e.g., occupational therapist, social worker) and paraprofessional (e.g., therapy assistant, personal care worker) groups. A combination of intensive training in professional boundaries and opportunities for ongoing professional development are important for all health practitioners.
Collapse
Affiliation(s)
- Patricia Fronek
- Spinal Injuries Unit, Queensland Spinal Cord Injury Service, Brisbane, Australia.
| | | | | | | | | | | |
Collapse
|
31
|
MacBean N, Ward E, Murdoch B, Cahill L, Solley M, Geraghty T, Hukins C. Optimizing speech production in the ventilator-assisted individual following cervical spinal cord injury: a preliminary investigation. Int J Lang Commun Disord 2009; 44:382-393. [PMID: 18821115 DOI: 10.1080/13682820802190339] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Mechanical ventilation is commonly used during the acute management of cervical spinal cord injury, and is required on an ongoing basis in the majority of patients with injuries at or above C3. However, to date there have been limited systematic investigations of the options available to improve speech while ventilator-assisted post-cervical spinal cord injury. AIMS To provide preliminary evidence of any benefits gained through the addition of positive end expiratory pressure (PEEP) and/or a tracheostomy speech valve to the condition of leak speech. METHODS & PROCEDURES Speech production in the three conditions was compared in two ventilator-assisted participants using a series of instrumental and perceptual speech measures. OUTCOMES & RESULTS The addition of PEEP or the use of a speech valve resulted in speech that was superior to leak speech for both participants; however, individual variation was present. CONCLUSIONS & IMPLICATIONS Leak speech alone or with the addition of PEEP or a tracheostomy speech valve can facilitate functional communication for the ventilated patient, though PEEP and valve speech were found to be superior in the current study. These findings will be of assistance for clinicians counselling the growing population of patients who may require tracheostomy positive pressure ventilation long-term regarding communication options.
Collapse
Affiliation(s)
- Naomi MacBean
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia.
| | | | | | | | | | | | | |
Collapse
|
32
|
Mackay-Sim A, Féron F, Cochrane J, Bassingthwaighte L, Bayliss C, Davies W, Fronek P, Gray C, Kerr G, Licina P, Nowitzke A, Perry C, Silburn PAS, Urquhart S, Geraghty T. Autologous olfactory ensheathing cell transplantation in human paraplegia: a 3-year clinical trial. Brain 2008; 131:2376-86. [PMID: 18689435 PMCID: PMC2525447 DOI: 10.1093/brain/awn173] [Citation(s) in RCA: 295] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Olfactory ensheathing cells show promise in preclinical animal models as a cell transplantation therapy for repair of the injured spinal cord. This is a report of a clinical trial of autologous transplantation of olfactory ensheathing cells into the spinal cord in six patients with complete, thoracic paraplegia. We previously reported on the methods of surgery and transplantation and the safety aspects of the trial 1 year after transplantation. Here we address the overall design of the trial and the safety of the procedure, assessed during a period of 3 years following the transplantation surgery. All patients were assessed at entry into the trial and regularly during the period of the trial. Clinical assessments included medical, psychosocial, radiological and neurological, as well as specialized tests of neurological and functional deficits (standard American Spinal Injury Association and Functional Independence Measure assessments). Quantitative test included neurophysiological tests of sensory and motor function below the level of injury. The trial was a Phase I/IIa design whose main aim was to test the feasibility and safety of transplantation of autologous olfactory ensheathing cells into the injured spinal cord in human paraplegia. The design included a control group who did not receive surgery, otherwise closely matched to the transplant recipient group. This group acted as a control for the assessors, who were blind to the treatment status of the patients. The control group also provided the opportunity for preliminary assessment of the efficacy of the transplantation. There were no adverse findings 3 years after autologous transplantation of olfactory ensheathing cells into spinal cords injured at least 2 years prior to transplantation. The magnetic resonance images (MRIs) at 3 years showed no change from preoperative MRIs or intervening MRIs at 1 and 2 years, with no evidence of any tumour of introduced cells and no development of post-traumatic syringomyelia or other adverse radiological findings. There were no significant functional changes in any patients and no neuropathic pain. In one transplant recipient, there was an improvement over 3 segments in light touch and pin prick sensitivity bilaterally, anteriorly and posteriorly. We conclude that transplantation of autologous olfactory ensheathing cells into the injured spinal cord is feasible and is safe up to 3 years of post-implantation, however, this conclusion should be considered preliminary because of the small number of trial patients.
Collapse
Affiliation(s)
- A Mackay-Sim
- National Centre for Adult Stem Cell Research, Eskitis Institute for Cell and Molecular Therapies, Griffith University, Brisbane, Qld, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
|
34
|
Féron F, Perry C, Cochrane J, Licina P, Nowitzke A, Urquhart S, Geraghty T, Mackay-Sim A. Autologous olfactory ensheathing cell transplantation in human spinal cord injury. Brain 2005; 128:2951-60. [PMID: 16219671 DOI: 10.1093/brain/awh657] [Citation(s) in RCA: 326] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Olfactory ensheathing cells transplanted into the injured spinal cord in animals promote regeneration and remyelination of descending motor pathways through the site of injury and the return of motor functions. In a single-blind, Phase I clinical trial, we aimed to test the feasibility and safety of transplantation of autologous olfactory ensheathing cells into the injured spinal cord in human paraplegia. Participants were three male paraplegics, 18-55 years of age, with stable, complete thoracic injuries 6-32 months previously, with stable spinal column, no implanted prostheses, and no syrinx. Olfactory ensheathing cells were grown and purified in vitro from nasal biopsies and injected into the region of damaged spinal cord. The trial design includes a matched injury group as a control for the assessors, who are blind to treatment status. Assessments, made before transplantation and at regular intervals subsequently, include MRI, medical, neurological and psychosocial assessments, and standard American Spinal Injury Association and Functional Independence Measure assessments. One year after cell implantation, there were no medical, surgical or other complications to indicate that the procedure is unsafe. There is no evidence of spinal cord damage nor of cyst, syrinx or tumour formation. There was no neuropathic pain reported by the participants, no change in psychosocial status and no evidence of deterioration in neurological status. Participants will be followed for 3 years to confirm long-term safety and to compare neurological, functional and psychosocial outcomes with the control group. We conclude transplantation of autologous olfactory ensheathing cells into the injured spinal cord is feasible and is safe up to one year post-implantation.
Collapse
Affiliation(s)
- F Féron
- Eskitis Institute for Cell and Molecular Therapies, Griffith University, Brisbane, Qld, Australia
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Fronek P, Booth S, Kendall M, Miller D, Geraghty T. The Effectiveness of a Sexuality Training Program for the Interdisciplinary Spinal Cord Injury Rehabilitation Team. Sex Disabil 2005. [DOI: 10.1007/s11195-005-4669-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
36
|
|
37
|
Tooth L, McKenna K, Geraghty T. Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting. Spinal Cord 2003; 41:220-30. [PMID: 12669086 DOI: 10.1038/sj.sc.3101433] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective, descriptive study. OBJECTIVES To describe patients' length of stay (LOS), functional status and discharge setting after rehabilitation and how degree of impairment (complete/incomplete paraplegia/tetraplegia) impacts on these outcomes. To compare actual LOS with estimated LOS. Estimated LOS was based on an Australian model, the Australian National Sub-acute and Non-acute Patient Classification System (AN-SNAP), which classifies patients using admission Functional Independence Measure (FIM trade mark ) scores. To further describe outcomes for each AN-SNAP class by degree of impairment. SETTING Spinal Injuries Unit of major Metropolitan hospital in Brisbane, Australia. METHODS Retrospective chart review of 167 patients with traumatic spinal cord injury (SCI). Main outcome measures were rehabilitation LOS, discharge FIM trade mark scores and discharge setting. Injury measures were degree of impairment, acute LOS and rehabilitation admission FIM trade mark scores. Standard demographic measures were also collected. RESULTS The median rehabilitation LOS was 83 days and mean discharge FIM trade mark scores 102 for all patients. These differed by impairment (incomplete paraplegia LOS 43, FIM 117; complete paraplegia LOS 96, FIM 109; incomplete tetraplegia LOS 64, FIM 100; complete tetraplegia LOS 206, FIM 78). Patients discharged to the community (noncare facility) ranged from 93% with incomplete paraplegia to 73% with complete tetraplegia. For patients in the three AN-SNAP classes with the lowest FIM scores, the actual LOS was up to twice the estimated LOS. A large variability in discharge outcomes was found within individual AN-SNAP classes, despite similar FIM trade mark scores on admission. CONCLUSIONS Rehabilitation outcomes differed substantially by impairment. The variability in outcomes for patients within the same AN-SNAP class questions the ability of this system to accurately predict LOS, and therefore cost of rehabilitation services, for patients with traumatic SCI in Australia.
Collapse
Affiliation(s)
- L Tooth
- School of Population Health, The University of Queensland, Brisbane, Australia
| | | | | |
Collapse
|
38
|
Booth S, Kendall M, Fronek P, Miller D, Geraghty T. Training the Interdisciplinary Team in Sexuality Rehabilitation Following Spinal Cord Injury: A Needs Assessment. Sexuality and Disability 2003. [DOI: 10.1023/b:sedi.0000010067.27044.7e] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
39
|
Abstract
A pregnant 26-year-old woman presented with an asymptomatic 10-cm left ovarian mass diagnosed at 19 weeks gestation. On removal, the tumor was shown to be a cribriform variant of basal cell salivary adenoma with no other teratomatous or germ cell tumor elements present. The pregnancy continued uneventfully to term and the patient remains symptom-free 10 months after diagnosis. Tissues of salivary type are occasionally observed within mature cystic teratomas of the ovaries and are presumed to have given rise to the present lesion, which is thought to be the first reported case of a neoplasm of salivary type arising in the ovaries.
Collapse
Affiliation(s)
- P Russell
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | | | | | | |
Collapse
|
40
|
Geraghty T, Thompson F. Plastic and reconstructive surgery in the Dominican Republic. Mo Med 1991; 88:91-7. [PMID: 2062298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- T Geraghty
- University of Missouri-Kansas City Medical School
| | | |
Collapse
|