Prediction of functional outcome after spinal cord injury: a task for the rehabilitation team and the patient

Study design: Descriptive analysis of data gathered in an information system.Objectives: To explore the predictions of professionals and patients regarding functional outcome after spinal cord injury related to the final results after inpatient rehabilitation, in order to make prognostics of rehabilitation outcome more successful and enlarge the role of the patient in selecting realistic rehabilitation goals.Methods: Data from 55 patients with spinal cord injury admitted to the rehabilitation centre. Expectations of the rehabilitation team and the patients regarding future independence in performing six daily activities were compared to the functional results at discharge. The results of patients with different level and extent of lesion were analyzed.Results: In 52% of all performed skills, independence was achieved at discharge. Professionals and patients made similar predictions. If they both expected independence after rehabilitation, 90% of the skills were performed independently at discharge. If they both did not expect independence only 3% of the functional results were positive. Of all combined predictions 64% was correct. Correct predictions were most often found regarding self-care skills of patients with paraplegia and regarding mobility of patients with complete lesions. Prediction of self-care outcome of patients with tetraplegia is far more complicated. There was a considerable variation in predictions of mobility potential, especially regarding patients with incomplete lesions. If the team and patients agreed upon expected independence in mobility skills of these patients, the final results were mostly positive.Conclusions: Prediction of functional outcome after spinal cord injury was most successful if the expectations of the team and patients were combined. Prognosis of self-care outcome of patients with paraplegia and mobility potential of patients with complete spinal cord lesions was usually clear at admission. However, selection of realistic goals concerning self-care skills of patients with tetraplegia and mobility skills of patients with incomplete lesions is far more complicated. Gradual adjustment of objectives is needed during the rehabilitation process in close collaboration between the professionals and the patients

When Thinking Impairs Sleep : Trait, Daytime and Nighttime Repetitive Thinking in Insomnia

We like to thank Dorien van Baar, Lisette van Breen, Rachel Renet, Marlene Stone, Britt van Hest, and Noraly Dekkers for their help with the data acquisition.Peer reviewedPublisher PD

Employment status, job characteristics and work-related health experience of people with a lower limb amputation in the Netherlands

Objectives: To describe the occupational situation of people with lower limb amputations in The Netherlands and to compare the health experience of workings and nonworking amputee patients with a nonimpaired reference population. Design: Cross-sectional study in which patients completed a questionnaire about their job participation. type of job, workplace adjustments to their limb loss, their position in the company, and a general health questionnaire. Setting: Orthopsdic workshops in The Netherlands with a population of lower limb amputees. Patients: Subjects were recruited from orthopedic workshops in the Netherlands. They ranged in age from Is to 60 years (mean, 44.5yr) and had a lower limb amputated at least 2 years (mean, 19.6yr) before this study. Main Outcome measures: A self-report questionnaire, with 1 part concerning patient characteristics and amputation-related factors, and the other concerning job characteristics, vocational handicaps, work adjustments, and working conditions; and a general health questionnaire (RAND-36) to measure health status. Results: Responses were received from 652 of the 687 patients (response: rate, 95%) who were sent the questionnaire. Sixty-foul percent of the respondents were working at the rime of the study (comparable with the employment rate of the general Dutch population), 31 % had work experience but were not presently working, and 5% had no work experience. After their amputations, people shifted to less physically demanding work. The mean delay between the amputation and the return to work was 2.3 years. Many people wished their work was better adjusted to the limitations presented by their disability and they mentioned having problems concerning possibilities fur promotion. Seventy-eight percent of those who stopped working within 2 years after the amputation said that amputation-related factors played a role in their decision. Thirty-four percent said that they might have worked longer if certain adjustments had been made. The health experience of people who were no longer working was significantly worse than that of the working people with amputations. Conclusions: Although amputee patients had a relatively good rate of job participation, they reported problems concerning the long delay between amputation and return to work, problems in finding suitable jobs, fewer possibilities for promotion, and problems in obtaining needed workplace modifications. People who had to stop working because of the amputation showed a worse health experience than working people

Do dental undergraduates think that Thiel-embalmed cadavers are a more realistic model for teaching exodontia?

Introduction: Teaching exodontia to novice undergraduates requires a realistic model. Thiel-embalmed cadavers retain the flexibility of the soft tissues and could be used to teach exodontia.Objective: The objective was to determine whether Thiel-embalmed cadavers were perceived to be a more realistic model by undergraduates in comparison with mannequins.Materials and Methods: Over a period of 4 years (2011-2014), students were randomly assigned into two groups: those taught exodontia on mannequins only (NT) and those who also experienced cadaveric teaching (T). This was followed by an assessment.Results: There were 174 students in the T group and 108 in the NT group. Sixty-five per cent of the T group and 69% of the NT group provided feedback. Ninety-eight per cent (98%) felt that they had been advantaged by being included in the group compared with 95% in the NT who felt disadvantaged. The majority (98%) thought that using the cadavers was advantageous and gave a realistic feel for soft tissue management (89%) and that it was similar to managing a patient (81%). Self-reported confidence in undertaking an extraction was not different between the two groups (P=.078), and performance in the extraction assessment was not significantly different between the two groups over the 4 years (P=.8).Conclusion: The Thiel-embalmed cadavers were well received by the students who found it a more realistic model for exodontia than a mannequin, even though this did not impact on their performance in a following assessment. Future work on these cadavers may be expanded to include surgical procedures.</p

Is rumination after bereavement linked with loss avoidance? : Evidence from eye-tracking

Funding: This research was funded by a Zon-MW TOP Grant of the Dutch Society for Scientific Research (NWO) under Grant number 91208009. Website: www.zonmw.nl. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.Peer reviewedPublisher PD